What’s the evidence 10.1

The NICE offers guideline on surgical site infection: https://www.nice.org.uk/guidance/CG74/

What is the SSI Bundle of Care?

The SSI Bundle of Care is a care bundle to prevent SSI involving 3 phases: a) preoperatively, b) intraoperatively, c) postoperatively.

What is the purpose of preoperative showering?

Preoperative showering reduces the amount of endogenous skin flora which is the main cause of SSI. However, there is lack of evidence to support the use of antiseptics for preoperative showering.

When is hair removal done? What should be used for hair removal? Why?

Hair removal is recommended that hair removal is not done routinely to reduce SSI. However if hair needs to be removed, electric clippers with a single-use head should be done on the day of surgery in theatres. Do not use razors as they increase the risk of SSI (increases the chance of cuts and abrasions thereby exposing the skin to infection).

When is antibiotic prophylaxis given? Why?

Antibiotics are not routinely used for clean non-prosthetic uncomplicated surgery. Antibiotic prophylaxis is given before (a) clean surgery involving placement of prosthesis or implant, (b) clean-contaminated surgery, (c) contaminated surgery.

Give antibiotics intravenously on starting anaesthesia. Timing is important. If tourniquet is used, antibiotics should be given prior to inflation.

Why is maintaining patient homeostasis important?

Maintaining patient homeostasis is important to a)prevent inadvertent perioperative hypothermia b)maintain adequate perfusion c)maintain blood glucose level especially in diabetes. These are important in preventing SSI.