CCHMC SSI Protocol • A basic set of interventions to prevent SSIs among Class I and Class II surgical procedures o Included: All surgical procedures involving a skin incision Proposed measures: *For sub-set of procedures • S aureus screening and decolonization – Class I/II procedures with sterile implant, excludes ports and CVCs • Antibiotic timing – Class I/II procedures for which antibiotics are recommended • Normothermia – All patients ≤5kg Intervention Definition Pre-op Bathing 1 Soap & Water, 1 CHG bath both occurring within 24 hours of procedure Linen Change Clean bed linens and gown/pajamas changed night prior to procedure S aureus Screening* 2-site screening within 2-6 weeks of procedure Decolonization* Decolonization protocol if positive including additional CHG bathing and mupirocin Intra-op Skin prep Alcohol-containing product, CHG preferred Antibiotic timing* Complete within 60min p/t incision pCO2 ETCO2 ≥40 during procedure unless contraindicated Normothermia* Core temp at incision closure ≥36.0 Post-op Wound Care Plan Documented plan in an Epic order
CCHMC SSI Protocol
Guideline · Aug 2019 · 1 min read
In brief
In brief
Cincinnati Children's Hospital Medical Center protocol for preventing surgical site infections in pediatric patients. Outlines standardized perioperative measures and infection control practices.
Written by the GCMD Library team from the guideline.
Protocol Scope and Applicability
This guideline applies to all Class I and Class II surgical procedures involving a skin incision at Cincinnati Children's Hospital Medical Center. The protocol establishes a standardized bundle of interventions designed to reduce surgical site infection rates across all qualifying procedures.
Preoperative Bathing Requirements
Patients must complete two baths within 24 hours before surgery: one with soap and water and one with chlorhexidine gluconate (CHG). Clean bed linens and patient gown or pajamas must be changed the night before the procedure to reduce skin bacterial colonization.
Staphylococcus aureus Screening and Decolonization
For Class I/II procedures involving sterile implants (excluding ports and central venous catheters), patients require two-site S. aureus screening performed 2-6 weeks preoperatively. Positive screens trigger a decolonization protocol including additional CHG bathing and mupirocin application.
Intraoperative Skin Preparation
Surgical site preparation must use an alcohol-containing antiseptic product, with chlorhexidine gluconate preferred when not contraindicated. Proper skin preparation technique is essential to reduce bacterial load at the incision site.
Prophylactic Antibiotic Administration
For procedures where antibiotics are recommended, prophylactic administration must be completed within 60 minutes prior to surgical incision. Appropriate timing ensures adequate tissue levels of antibiotic at the time of bacterial exposure.
Intraoperative Carbon Dioxide Management
End-tidal CO2 (ETCO2) should be maintained at ≥40 mmHg throughout the procedure unless clinically contraindicated. Adequate CO2 levels support tissue perfusion and immune function during surgery.
Perioperative Normothermia Maintenance
Core body temperature must be ≥36.0°C at the time of incision closure, with particular attention to all patients weighing ≤5 kg. Maintaining normothermia supports immune function and reduces infection risk in the immediate postoperative period.
Postoperative Wound Care Documentation
A documented wound care plan must be entered as an Epic order before the patient leaves the operating room. Clear postoperative wound management instructions ensure consistent care and early identification of potential complications.
Statements in this guideline
The protocol applies to all surgical procedures involving a skin incision classified as Class I or Class II.
Patients should receive one soap and water bath and one chlorhexidine gluconate bath, both occurring within 24 hours of the procedure.
Clean bed linens and gown or pajamas should be changed the night prior to the procedure.
Two-site Staphylococcus aureus screening should be performed within 2 to 6 weeks of the procedure for Class I and Class II procedures with sterile implant, excluding ports and central venous catheters.
If Staphylococcus aureus screening is positive, a decolonization protocol including additional chlorhexidine gluconate bathing and mupirocin should be implemented.
Skin preparation should use an alcohol-containing product, with chlorhexidine gluconate preferred.
Antibiotic administration should be completed within 60 minutes prior to incision for Class I and Class II procedures for which antibiotics are recommended.
End-tidal carbon dioxide should be maintained at 40 mmHg or greater during the procedure unless contraindicated.
Core temperature at incision closure should be 36.0 degrees Celsius or greater for all patients weighing 5 kg or less.
A wound care plan should be documented in an Epic order.