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 |