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).
Colorectal Surgery SSI Protocol
Guideline · Aug 2019 · 1 min read
In brief
In brief
Clinical protocol for preventing surgical site infections in colorectal surgery patients, covering perioperative measures and infection control strategies.
Written by the GCMD Library team from the guideline.
Pre-Hospital Patient Preparation
Patients should shower or bathe the evening before surgery using antibiotic or regular soap. Chlorhexidine wipes are applied on the morning of surgery in Same Day Surgery or on the wards if already admitted.
Pre-Incision Surgical Site Preparation
Hair removal should be performed with clippers if needed. Surgical field preparation uses Chloraprep (or betadine plus alcohol if contraindicated), and appropriate prophylactic antibiotics must be administered within 30 minutes prior to incision with intraoperative re-dosing as needed.
Intra-Operative Wound Protection and Contamination Control
Routine use of fascial wound protectors (ALEXIS) is required for both open and laparoscopic extraction sites. Surgeons and scrub personnel must perform gown and glove changes prior to fascial closure, and clean towels or new drapes are placed around the wound if contamination occurs.
Intra-Operative Physiologic Optimization
The anesthesia team maintains normothermia, euglycemia (blood glucose <180 mg/dL), and intraoperative hyperoxygenation (60-80% FiO2 throughout the case, reduced to 40% at skin closure prior to extubation). These measures reduce surgical site infection risk through optimized tissue perfusion and immune function.
Wound Closure Technique
A dedicated wound closure tray with fresh instruments is used for fascial and skin closure. The wound is irrigated with normal saline after fascial closure, and tissue layers are approximated with interrupted deep dermal sutures to allow free drainage, avoiding water-tight subcuticular closures or dermabond at bowel extraction sites.
Post-Operative Management
No post-operative antibiotics are given for Class I/II wounds, and prophylactic antibiotics are limited to 24 hours for other wound classes unless treating active infection. Normothermia, euglycemia, and 40% FiO2 by facemask are maintained in PACU, and dressings are removed within 48 hours with daily wound inspection.
Applicable Procedures
This protocol applies to colorectal procedures including ileostomy/colostomy creation or closure, bowel resection, PSARP/PSARVUP with laparotomy, staged Hirschsprung pullthrough with laparotomy, Malone creation, vaginal reconstruction using bowel, and bowel tapering procedures. Consideration should be given for exploratory laparotomy for perforated viscus excluding appendicitis.
Statements in this guideline
Patients should shower or bathe on the evening prior to surgery using antibiotic or regular soap.
Chlorhexidine wipes should be applied on the morning of surgery in Same Day Surgery or on the wards if admitted.
Hair removal, if applicable, should be performed with clippers.
Surgical field preparation should use Chloraprep, or betadine AND alcohol if Chloraprep is contraindicated.
Appropriate antibiotics should be administered within 30 minutes prior to incision with re-dosing intraoperatively.
A fascial wound protector (ALEXIS) should be used routinely for both open and laparoscopic extraction sites.
The anesthesia team should monitor and maintain normothermia, euglycemia with blood glucose below 180 mg/dL, and intraoperative hyperoxygenation at 60-80% FiO2 throughout the case and 40% at skin closure prior to extubation.
Surgeons and scrub personnel should perform gown and glove change prior to fascial closure.
Clean towels should be placed around the wound prior to fascia and skin closure.
If drapes are grossly contaminated or soaked through with fluids, a new laparotomy drape should be placed.
A dedicated wound closure tray should be used for fascia and skin, and the bovie and suction tip/tubing should be replaced.
The wound should be irrigated with normal saline once the fascia is closed; antibiotic solution is not necessary.
Tissue layers and skin should be approximated with interrupted deep dermal sutures to allow for free drainage, and water-tight subcuticular closures should be avoided.
Dermabond should not be used on the incision of a bowel extraction site but may be used at other clean incisions.
Proper wound classification should be ensured at the end of the case and announced during the final time out.
No post-operative antibiotics should be given for Class I/II wounds.
Prophylactic post-operative antibiotics should be limited to 24 hours for all wound classes other than Class I/II.
Continuation of antibiotics beyond 24 hours should occur only if treating active infection.
Normothermia, euglycemia, and 40% FiO2 by facemask should be maintained in the PACU.
Dressings should be removed within 48 hours if applicable, and daily inspection of the wound should be performed.