The document discusses surgical site infection care bundles. It defines a surgical site infection as an infection related to a surgical procedure that occurs within 30 days of surgery or up to 90 days if an implant is involved. It then classifies SSIs as superficial incisional, deep incisional, or organ/space infections depending on the site and timing. The rest of the document outlines a care bundle with evidence-based practices to prevent SSIs, including proper hair removal and skin prep, tight glucose control, antibiotic prophylaxis timing, and wound care after surgery.

1. Surgical site infection care bundle
Mathivathani M
Clinical instructor
KGMU College of Nursing

2. SURGICAL SITE INFECTION
• The CDC defines - SSI as an infection related to a surgical
procedure that occurs near the surgical site within 30 days
following surgery (or up to 90 days following surgery where an
implant is involved)

3. Classification

4. Conts…
 Event occurs within 30
days
 Purulent drainage from
wound.
 Positive wound
culture.
 Pain, redness,
swelling.
 Diagnosis by surgeon.
 Event occurs
within 30-90 days
 Purulent drainage
from deep aspect
of the wound
 Dehiscence
 Fever > 380 C
 Abscess on other
evidence
histopathology/Gr
oss anatomy/
imaging study
Superficial incisional SSI Deep incisional SSI
Organ/Space SSI
 Event occurs within 30-90
days
 Involved deeper
(cavity/organ)
 Purulent drainage from
deep aspect of the wound
 Dehiscence
 Fever > 380 C
 Abscess on other evidence
involvement of organ
histopathology/Gross
anatomy/ imaging study

5. What is care bundle?
A 'care bundle' is a collection of interventions/ Set of
evidence based practice

6. Core Prevention Strategies- Pre-Operative
Do NOT remove patient hair, or if absolutely
necessary, remove with a clipper, do not shave
1
2
• Do not use antibiotic prophylaxis routinely for
uncomplicated clean surgeries without
prosthetic implants.
• Administer surgical antibiotic prophylaxis in the
120 minutes preceding surgical incision
(depending on the type of operation and the half-
life of the antibiotic)

7. 3
Skin Prep: Use appropriate alcohol
containing antiseptic agent (unless
contraindicated) and technique for
skin preparation
Maintain normothermia in patient
throughout the surgery.
4

8. Maintain normoglycaemia in patient
throughout the surgery. Screen
preoperative blood glucose levels and
maintain tight glucose control POD#1 and
POD#2 in patients undergoing select
elective procedures
Carry out mechanical bowel preparation
always combined with administering
preoperative oral antibiotics in adults
patients undergoing elective
colorectal surgery
5
6

9. Intra operative Measures
Operating Room (OR) Traffic
Keep OR doors closed during
surgery except as needed for
passage of equipment,
personnel, and the patient
1
2
Use sterile Surgical attire
Use sterile drapes and sterile
instruments

10. Surgical Wound Dressing
Protect primary closure incisions with
sterile dressing for 24-48 hrs post-op
Control blood glucose level during the
immediate post-operative period
(cardiac surgeries)
Maintain post-op blood glucose level
at <200mg/dL
Post operative Measures
9
10

11. Advise the Patient bathes or showers
prior to surgery with either plain or
antimicrobial soap / Antiseptic agent
Use 2% mupirocin decolonization in
known nasal carriers of Staphylococcus
aureus in cardiac and orthopedic
surgery
(consider for other surgeries)
1
2
Supplemental Prevention Strategies- Pre operative

12. • Redose antibiotic at the 3 hr interval in
procedures with duration >3hrs.
•Adjust antimicrobial prophylaxis dose
for obese patients (body mass index
>30)
3
Peri operative
•Use at least 80 % fraction of inspired
oxygen intraoperatively and
immediately postoperatively in select
procedure.
4

13. Before initiating any antibiotic for
suspected SSI, wound sample must be
sent for culture to microbiology lab.
5
Post operative