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Table 2 Evidence-based care bundle elements.

From: Expert commentary on the challenges and opportunities for surgical site infection prevention through implementation of evidence-based guidelines in the Asia–Pacific Region

Bundle elements Classa Mechanistic benefits
Evidence-based interventions
Normothermia 1A Less bleeding/preserve immune function in wound bed/enhanced wound healing
Perioperative weight-based antimicrobial prophylaxis 1A Tissue antisepsis/intraoperative conc > MIC [90] wound pathogens
Glycaemic control 1A Preserve granulocytic immune function/enhance wound healing
Antimicrobial (triclosan) coated sutures (fascia/subcuticular closure) 1A Mitigate nidus of infection/local tissue antisepsis
Preadmission CHG showering/bathing 1B Skin antisepsis/reduce skin bioburden
Perioperative skin prep with 2% CHG/70% alcohol 1A Skin antisepsis/reduce skin bioburden
Separate wound closure tray II Mitigate instrument contamination
Glove change prior to fascia/subcuticular closure II Disrupt cross-contamination across tissue planes
Supplemental evidence-based interventions
Supplemental oxygen (colorectal surgery) 1A Enhanced tissue oxygenation and immune function/ metabolic benefits/wound healing
Oral antibiotics/mechanical bowel prep (colorectal surgery) 1A Reduce bioburden within the bowel lumen and on brush border surfaces
Wound edge protector (colorectal, vascular and OB/GYN surgeries) 1B Intraoperative wound antisepsis/minimising wound contamination
Staphylococcal decolonization (orthopaedic and CT surgeries) 1A Mitigate S. aureus and MRSA pathogenicity
Smoking cessation (orthopaedic, neurological, CT, and likely all surgeries) 1B Preserve angiogenesis/reduce risk of dehiscence/enhance wound healing
Intraoperative irrigation of the surgical wound with 0.05% CHG II Mitigate wound contamination prior to closure
OR traffic control – minimize door openings No recommendation/unresolved Reduce OR air bioburden
  1. CHG, chlorhexidine gluconate; CT, cardiothoracic; MRSA, methicillin-resistant Staphylococcus aureus; OB/GYN, obstetrics/gynaecology; OR, operating room, conc > MIC [90], concentration greater than the minimal inhibitory concentration required to inhibit the growth of 90% of surgical wound pathogens
  2. aColumn 2: Interventional evidence-based criteria derived from “CDC SSI Guidelines Evidence-Based Criteria documentation and Wisconsin Division of Public Health Service Supplemental Guidance for the Prevention of Surgical Site Infections: An Evidence-based Perspective [6062]. CDC categories: 1A = strong recommendation supported by high to moderate–quality evidence suggesting net clinical benefits or harms; 1B = strong recommendation supported by low-quality evidence suggesting net clinical benefits or harms or an accepted practice (eg, aseptic technique) supported by low to very low–quality evidence; 1C = A strong recommendation required by state or federal regulation; Category II = weak recommendation supported by any quality evidence suggesting a trade-off between clinical benefits and harms; No recommendation/unresolved issue = An issue for which there is low to very low–quality evidence with uncertain trade-offs between the benefits and harms or no published evidence on outcomes deemed critical to weighing the risks and benefits of a given intervention