9 recommendations to prevent surgical site infection via patient engagement

Undergoing a surgical procedure is enough to worry about for a patient, yet many have the additional fear of developing surgical site infections (SSIs). A study published in Antimicrobial Resistance & Infection Control outlines nine recommendations for patients to take charge of their own care and reduce the chances of developing an SSI using patient engagement.

These infections increase risks of morbidity and mortality while driving up healthcare costs. Current practice methods addressing SSI prevention focus on improvement from the provider side. But this study took another route by aiming to engage patients to reduce SSI rates.

A panel of healthcare experts provided patients with a leaflet with information on pre-, intra- and postoperative care. Recommendations for the prevention of SSIs included:

1. Staphylococcus aureus screening and decolonization: Patients undergoing high-risk surgery should have a nasal screening to identify carriers for methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA). Carriers should receive decolonization treatment up to five days before surgery.
2. Smoking: Patients should inform physicians about smoking habits before surgery and quit smoking at least four weeks before the procedure.
3. Hair removal: Patients should not remove body hair up to five days prior to the surgery on the planned incision side to avoid microabrasions to the skin.
4. Hand hygiene: Patient should clean their hands using alcohol-based rub or soap and water before eating a meal, after using the restroom, before and after touching the wound or bandages and touching their IV or drainage bag/tube. Healthcare workers must also wash hands accordingly. If the patient does not see the healthcare worker wash their hands, speak up. Visitors should not touch the patients’ wounds or bandages.
5. Body temperature: It is important the patient does not cool down before or during surgery.
6. Preoperative showering and bathing: Patients must make sure their skin is clean by showering or bathing with soap or antiseptic agents the night before or morning of surgery.
7. Diabetes mellitus: Patients with diabetes must see their physicians a month before surgery, maintain stable blood sugar levels at all stages of surgery and inform hospital staff of their routine insulin schedule.
8. Wound care after surgery: Patients must keep wound dressings on 48 hours after surgery unless indicated otherwise, clean excess wound leakage using aseptic, ensure healthcare workers have proper hand hygiene when changing dressings, make sure visitors do not tough wound dressings, make sure they understand how to care for their wounds at discharge and if any symptoms of redness or pain appear to contact their physician or nurse.
9. Multidrug-resistant organism (MDRO) risk: Patients should inform their physician about travel history and recent hospitalizations abroad in Southern and Eastern Europe, Middle East and North Africa due to the fact these counties have high risks for MDRO.

“Patient engagement in preventing SSI might be an effective and useful strategy adding to the already existent surgical site care bundles. Yet, this topic is still at its infancy and deserves further rigorous studies to support the effectiveness of patient focused interventions in preventing surgical site infections,” concluded E. Tartari, Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, first author on the study, and colleagues. “The elements recommended here, require further testing to define the optimal “bundle” that is effective and is regarded as acceptable part of quality improvement by HCWs and patients as well. Furthermore, patient engagement has the potential to help implementing current SSI guidelines into routine clinical practice. This aspect should be addressed through improving interventions that support patient education and encourage an active participatory role throughout the surgical care.”