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Prevention of SSIs After Major Gynecologic Surgery

Obstet Gynecol; ePub 2016 Dec 2; Pellegrini, et al

The American College of Obstetricians and Gynecologists and the Council on Patient Safety in Women’s Health Care has issued a consensus bundle on the prevention of surgical site infections (SSIs) after major gynecologic surgery. The purpose of the safety bundle, which is organized into 4 domains (Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning), is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of SSI. Recommendations include:

Readiness (Every Facility)

  • Establish standard preoperative care instructions and education for women undergoing major gynecologic surgery (such as hysterectomy), including postoperative wound care instructions (written and verbal).
  • Establish a system that delineates responsibility for every member of the surgical team.
  • Establish standards for temperature regulation with regard to:
    • Ambient operating room temperature.
    • Patient normothermia.
  • Standardize the selection and timing of administration of prophylactic antibiotics, ideally using order sets or checklists.
  • Standardize the timing of discontinuation of prophylactic antibiotics, ideally using order sets or checklists.
  • Establish standard on appropriate skin preparation, both preoperatively and postoperatively.

Recognition and Prevention (Every Patient)

  • Assess patient risk preoperatively for surgical site infection using the following criteria:
    • Blood glucose level
    • Body mass index
    • Immunodeficiency
    • Methicillin-resistant Staphylococcus aureus status
    • Nutritional status
    • Smoking status

Response (Every Case)

  • Develop intraoperative “Timeouts” to address antibiotic dosage, timing, prophylaxis issues, and patient-specific issues.
  • Reassess patient risk for surgical site infection based on length of surgery, potential bowel incision, vaginal contamination, and amount of blood loss.
  • Provide postoperative care instructions and education to women undergoing major gynecologic surgery (such as hysterectomy) and family members or other support persons.

Reporting and Systems Learning (Every Facility)

  • Establish a culture of huddles for high-risk patients.
  • Create system to analyze and report surgical site infection data.
  • Monitor outcomes and process metrics.
  • Actively collect and share physician-specific surgical site infection data with all surgeons as part of their ongoing professional practice evaluation.
  • Standardize a process to actively monitor and collect surgical site infection data with postdischarge follow-up.

Citation:

Pellegrini JE, Toledo P, Soper DE, et al. Consensus bundle on prevention of surgical site infections after major gynecologic surgery. [Published online ahead of print December 2, 2016]. Obstet Gynecol. doi:10.1097/AOG.0000000000001751.