Colorectal Surgery SSI Protocol Checklist

Date of procedure: Patient name and MRN (or sticker): Cases to be used for: Creation/closure of ileostomy/colostomy, bowel resection, PSARP or PSARVUP with laparotomy, staged Hirschprung’s pullthrough with laparotomy, creation of Malone, vaginal reconstruction/replacement using bowel, bowel tapering procedures. Can consider for ex lap for perforated viscus (excluding appendicitis). Updated 4/2019 v2 Colorectal Surgery SSI Protocol Checklist 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) Pre-Incision  Hair removal (if applicable) with clippers  Surgical field prep with Chloraprep (if contra-indication to Chloraprep then use betadine AND alcohol). Allow adequate drying time for prep (per current OR standards).  Appropriate antibiotics within 30 min prior to incision (with re-dosing intraoperatively) Intra-Operative  Routine use of fascial wound protector (ALEXIS) for both open and laparoscopic extraction sites. (If already being utilized, GelPort counts as wound protector).  Ioban allowed, but not required.  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 bovie and 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 dermabond on incision of a bowel extraction site. (Can use dermabond at other clean incisions).  Ensure proper wound classification at end of case and announce during final time out. 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 Surgeon name and signature: __________________________________________________________ OR nurse name and signature: _________________________________________________________