SSI Prevention Checklist - Colorectal Protocol

Closing

Intra-Operative

Pre-Incision

Pre-Operative

Use this guide to learn how to help prevent

surgical site infections.

Please click on the section headings to begin.

Content: Illustrations:

Patrick Sullivan, MD Cheryl Castleberry, RN BSSatyen Tripathi, MA CMI

Pre-Operative

Pre-Incision

Intra-Operative

Closing

Pre-Operative Steps

1. Set OR Temperature

Pre-Operative

Pre-Incision

Intra-Operative

Closing

Set OR Temperature

Set operating room temperature to between 72° and 75° F.

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Pre-Operative

Pre-Incision

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Pre-Incision Steps

4. Double-glove1. Administer Antibiotic

5. Initiate Intra-operative Warming

2. Prep Skin

3. Perfom Universal Prep 6. Prepare General Closing Pan

Pre-Operative

Pre-Incision

Intra-Operative

Closing

Administer Antibiotic

If PCN allergy, give clindamycin (900mg) and aztreonam (2g).

Typical dose is Ancef (2g) and Flagyl (500mg).Administer within one hour of incision.

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Prep Skin

Use Chloraprep® (Betadine® for perineum).Allow for 3 minute drying time.

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Perform Universal Prep

Click here to see sample technique

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Use sterile draping techniques and Ioban occlusive to decrease risk of openings for contamination.

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Pre-Incision

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Closing

Universal Prep - Towel Surgical Site

Use sterile towels to frame surgical site.

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Pre-Operative

Pre-Incision

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Universal Prep - Apply Drape

Drape surgical site. Either universal orlaparotomy with pockets (surgeon’s preference).

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Pre-Operative

Pre-Incision

Intra-Operative

Closing

Universal Prep - Use Ioban

Place Ioban covering over surgical site.

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Pre-Operative

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Intra-Operative

Closing

Double-Glove

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All surgical team double-gloves.

Pre-Operative

Pre-Incision

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Closing

Initiate Intra-Operative Warming

Initiate intra-operative warming of patient.

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Pre-Operative

Pre-Incision

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Prepare General Closing Pan

Items to include on small Mayo: closing sutures, sterile towels, fresh gloves, closing pan instruments, Bovie, and suction.

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Cover pan with sterile protection until needed.

Pre-Operative

Pre-Incision

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Closing

Intra-Operative Steps

1. Use Alexis Wound Protecor

2. Perform Irrigation

Pre-Operative

Pre-Incision

Intra-Operative

Closing

Use Alexis Wound Protector

Use Alexis wound protector to prevent contamination and trauma to abdominal wall.

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Perform Irrigation

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Appropriate dose is: 500ml warm NaCl, Gentamycin (240mg) and Clindamycin (600mg)

Perform abdominal wound irrigation with antibiotic solution

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Pre-Incision

Intra-Operative

Closing

Closing Steps

5. Pass Off New Suction And Bovie

7. Close Skin1. Remove Instruments

6. Close Fascia

8. Apply Sterile Dressing

2. Retrieve Closing Pan

3. Re-Glove

4. Re-Towel Surgical Wound

Click on video to review the closing technique.

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Pre-Incision

Intra-Operative

Closing

Remove Instruments

Remove hardware and instruments from field; keep drapes. Remove wound protector.

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Retrieve Closing Pan

Bring prepared closing table close to patient.

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Re-Glove

All surgical team re-gloves. Remove outer gloves and replace.

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Gowns are done if preferred by surgeon.

Pre-Operative

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Closing

Re-Towel Surgical Wound

Re-towel the surgical wound with the towels from prepared closing pan.

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Pre-Operative

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Pass Off New Bovie and Suction

Pass off new Bovie and suction from prepared closing pan.

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Pre-Operative

Pre-Incision

Intra-Operative

Closing

Close Fascia

Close fascia with new instruments from closing pan.Do not reuse instruments.

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Pre-Operative

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Closing

Skin Closure

Close skin - staples or suture - surgeon preference.

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Skin should be left open for Class III and IV wounds.

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Closing

Apply Sterile Dressing

Apply sterile dressing prior to taking off sterile drapes. Peel back Ioban without going outside sterile field.

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Primapore or sterile 4x4 with tegaderm (surgeon preference)

Pre-Operative

Pre-Incision

Intra-Operative

Closing

Summary of Steps

1

Pre-Operative StepsSet OR temperature 1

Pre-Incision StepsAdminster antibiotic

2 Prep skin

3 Perform universal prep

4 Double-glove

5 Initiate intra-operative warming

6 Prepare general closing pan

1

Intra-Operative StepsUse Alexis wound protector

2 Perform irrigation

1

Closing StepsRemove instruments

2 Retrieve closing pan

3 Re-glove

4 Re-towel surgical wound

5 Pass off new suction and bovie

6 Close fascia

7 Close skin

8 Apply sterile dressing