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: _________________________________________________________
Colorectal Surgery SSI Protocol Checklist
Guideline · Aug 2019 · 2 min read
In brief
In brief
Standardized protocol checklist for preventing surgical site infections in colorectal procedures, covering perioperative infection control measures and quality assurance steps.
Written by the GCMD Library team from the guideline.
Pre-Hospital Preparation
Patients undergo standardized skin preparation including bathing the evening before surgery and chlorhexidine wipe application on the morning of the procedure. This pre-operative decolonization protocol aims to reduce skin bacterial load prior to surgical intervention.
Pre-Incision Protocols
Surgical site preparation includes clipping hair if needed, chlorhexidine-based skin prep with adequate drying time, and prophylactic antibiotic administration within 30 minutes of incision. These measures establish optimal conditions for surgical field sterility and infection prevention.
Intra-Operative Wound Protection
Routine use of fascial wound protectors (ALEXIS device) is required for all open and laparoscopic extraction sites to minimize bacterial contamination of the wound edges. Optional Ioban draping may be used as an additional barrier.
Intra-Operative Closure Technique
Surgeons and scrub personnel perform gown and glove changes before fascial closure, and clean towels or new drapes are placed around the wound. A dedicated wound closure instrument tray with fresh bovie and suction equipment is used to minimize cross-contamination from the bowel procedure.
Wound Closure Strategy
After fascial closure, wounds are irrigated with normal saline and skin is approximated using interrupted deep dermal sutures to allow drainage rather than watertight subcuticular closure. Dermabond is avoided at bowel extraction sites but may be used at other clean incisions to reduce risk of fluid accumulation and infection.
Post-Operative Antibiotic Management
Prophylactic antibiotics are discontinued immediately for clean/clean-contaminated wounds (Class I/II) and limited to 24 hours maximum for contaminated wounds. Continuation beyond 24 hours is reserved only for treatment of established infection, not prophylaxis.
Post-Operative Wound Care
Patients are maintained with normothermia, euglycemia, and supplemental oxygen (40% FiO2) in the recovery room to optimize tissue perfusion and healing. Dressings are removed within 48 hours and wounds are inspected daily to enable early detection of complications.
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.
The surgical field should be prepped with Chloraprep, or if contraindicated, with betadine AND alcohol, allowing adequate drying time per current OR standards.
Appropriate antibiotics should be administered within 30 minutes prior to incision with re-dosing intraoperatively.
Fascial wound protector (ALEXIS) should be used routinely for both open and laparoscopic extraction sites.
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.
Tissue layers and skin should be approximated with interrupted deep dermal sutures to allow for free drainage, and it is acceptable to leave the wound open.
Water tight subcuticular closures should be avoided.
Dermabond should not be used on the incision of a bowel extraction site but can be used at other clean incisions.
Proper wound classification should be ensured at the end of the case and announced during 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 only occur if treating active infection.
Normothermia, euglycemia, and 40% FiO2 by facemask should be maintained in PACU.
The dressing should be removed within 48 hours if applicable, and daily inspection of the wound should be performed.