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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