Colorectal Surgery SSI Protocol

Colorectal Surgery SSI Protocol Pre-Hospital•Patient education•Shower/bath on evening prior (antibiotic or regular soap) •Chlorhexidine wipes on morning of (in Same Day Surgery or on the wards if admitted) Updated 3/2019 Intra-Operative•Routine use of fascial wound protector (ALEXIS) for both open and laparoscopic extraction sites. (If already being utilized, GelPortcounts as wound protector). •Iobanallowed, but not required.•Anesthesia team to monitor and maintain: normothermia, euglycemia (BG<180) and intraoperative hyperoxygenation (60-80% FiO2 throughout case, 40% at skin closure prior to extubation)•Gown and glove change by surgeons and scrub prior to fascial closure•Place clean towels around wound prior to fascia/skin closure. If drapes are grossly contaminated or soaked through with fluids, new laparotomy drape to be placed. •Use dedicated wound closure tray for fascia and skin. Replace bovieand suction tip/tubing. •Irrigation of wound once fascia is closed (using normal saline; antibiotic solution not necessary).•Approximate tissue layers and skin with interrupted deep dermal sutures to allow for free drainage (okay to leave wound open). Avoid water tight subcuticular closures. No dermabondon incision of a bowel extraction site. (Can use dermabondat other clean incisions). •Ensure proper wound classification at end of case and announce during final time out. Pre-Incision•Hair removal (if applicable) with clippers•Surgical field prep with Chloraprep(if contra-indication to Chloraprepthen use betadine ANDalcohol). •Appropriate antibiotics within 30 min prior to incision (with re-dosing intraoperatively) Post-Operative•Standard use of post-operative antibiotics: no post-operative antibiotics for Class I/II wounds; limit prophylactic post-operative antibiotics to 24 hours for all other wound classes. Continuation of antibiotics beyond 24 hours only if treating active infection.•Normothermia, euglycemia, and 40% FiO2 by facemask in PACU. •Dressing removed within 48 hours (if applicable) and daily inspection of wound. Cases to be used for: •Creation/closure of ileostomy/colostomy•Bowel resection•PSARP or PSARVUP with laparotomy•Staged Hirschprung’spullthroughwith laparotomy•Creation of Malone•Vaginal reconstruction/replacement using bowel•Bowel tapering procedures. •Consider for ex lap for perforated viscus (excluding appendicitis).