Surgical Site Infection Prevention

Most surgical site infections are preventable — and the interventions that matter most happen in a tight window before, during, and immediately after the incision. Missing that window changes outcomes.

Surgical site infection (SSI) prevention centers on a bundle of time-sensitive nursing actions. Preoperatively, the patient receives prophylactic antibiotics within 60 minutes before surgical incision (120 minutes for vancomycin or fluoroquinolones); the specific agent varies by procedure type and allergy history, with cefazolin being the most common choice. Prophylactic antibiotics are discontinued within 24 hours postoperatively (48 hours for cardiac surgery). Hair removal at the surgical site uses clippers, never razors — razors create microabrasions that harbor bacteria. The patient showers or bathes with chlorhexidine gluconate (CHG) the night before and morning of surgery. Blood glucose should be maintained below 180 mg/dL perioperatively, even in non-diabetic patients, because hyperglycemia impairs neutrophil function. Intraoperatively, normothermia is maintained — core temperature above 36°C (96.8°F) — because hypothermia causes vasoconstriction and reduces oxygen delivery to the wound. Postoperatively, the original surgical dressing stays intact for 24–48 hours unless soiled or the provider orders otherwise. When assessing the incision, you're looking for the classic signs — increasing redness, warmth, swelling, purulent drainage, wound dehiscence, or fever developing 48–72 hours post-op. SSIs are classified by depth: superficial incisional (skin and subcutaneous), deep incisional (fascia and muscle), and organ/space (any anatomy opened during the procedure).

Key Distinctions

Don't confuse SSI prevention (site-specific, time-bound bundle) with general sterile technique — SSI bundles are time-anchored interventions pegged to specific hours before and after incision, whereas sterile technique is a continuous standard maintained throughout any invasive procedure. Students mix up the antibiotic timing: it's within 60 minutes before incision, not at induction or after. A common error is thinking any postoperative fever signals SSI — fever in the first 24 hours is traditionally attributed to a pulmonary cause (Wind) in the postoperative fever mnemonic and is typically noninfectious. SSI fever typically appears at 48–72 hours or later.

Clinical Pearl

Think 'Clip, CHG, Cefazolin, Cover' — clip hair (never shave), CHG bath, cefazolin within 60 minutes, and keep that dressing covered for 24–48 hours.