Definition (CDC/NHSN): Surgical Site Infection occurs within 30 days of the index procedure (or within 1 year if an implant is left in place and the infection appears related to the operation) and involves the skin, subcutaneous tissue, deep soft tissues, or organs/spaces opened or manipulated during surgery.
SSI Classification
| Type | Depth | Criteria |
|---|---|---|
| Superficial | Skin & subcutaneous | Within 30 days; purulent discharge, positive culture, or surgeon diagnosis |
| Deep Incisional | Fascia & muscle | Purulent discharge from deep incision; dehiscence; surgeon opens wound; fever + localised pain |
| Organ/Space | Organs or spaces | Drain placed through stab wound; positive culture from aspirate; imaging evidence |
Incidence & Impact
- Affects 2–5% of surgical patients globally
- Leading cause of hospital readmission post-surgery
- Prolongs LOS by 7–11 days on average
- ~$10,000–$25,000 USD additional cost per SSI episode
- 3rd most common healthcare-associated infection (HAI) worldwide
- SSI mortality risk up to 3× higher in organ/space infections
- JCI requires SSI surveillance data as a core metric
Microbiology of SSI
| Organism | Frequency | Clinical Note |
|---|---|---|
| Staphylococcus aureus | Most common (#1) | Skin flora; nasal carriage 20–30%; golden pus, localised swelling |
| MRSA | High in GCC | Requires decolonisation + contact precautions; vancomycin/daptomycin |
| CoNS (S. epidermidis) | Common | Implant-related SSI; biofilm formation; often indolent presentation |
| E. coli / Klebsiella | Abdominal surgery | GI flora; often polymicrobial; bowel prep reduces but does not eliminate |
| Pseudomonas aeruginosa | ICU / burns | Environmental contamination; anti-pseudomonal coverage needed |
| Candida spp. | Immunocompromised | Diabetics, post-bone marrow transplant; fluconazole or echinocandin |
| Enterococcus | GI / urological | VRE increasingly reported; limited antibiotic options |
NNIS Risk Index — SSI Risk Stratification
Each factor scores 1 point. Total = 0–3. Higher score = higher SSI risk.
| Factor | Threshold | Score |
|---|---|---|
| ASA Physical Status | Grade III, IV, or V | +1 |
| Wound Classification | Contaminated or Dirty/Infected | +1 |
| Operative Duration | Exceeds 75th percentile for procedure type (T-point) | +1 |
0
~1% SSI
1
~2–3% SSI
2
~5–8% SSI
3
~10–17% SSI
Wound Classification
| Class | Description |
|---|---|
| Clean (I) | Elective, non-traumatic, no inflammation, no GI/GU/respiratory entry |
| Clean-Contaminated (II) | GI/GU/respiratory tract entered under controlled conditions |
| Contaminated (III) | Open traumatic wound, major break in sterility, gross GI spillage |
| Dirty (IV) | Old traumatic wound with devitalised tissue, existing infection, viscus perforation |
JCI Surveillance Requirements
- Standardised SSI definition (CDC/NHSN criteria)
- Prospective surveillance for 30 days post-procedure
- Procedure-specific SSI rates tracked and benchmarked
- Monthly reporting to hospital infection control committee
- Pre-op antibiotic prophylaxis compliance tracked (%)
- Bundle compliance audits (skin prep, glycaemia, normothermia)
- Root cause analysis for SSI outlier events
- Staff education and training annually documented
Bundle Principle: Pre-operative SSI prevention is a bundle — compliance with ALL elements produces greater benefit than individual components. Aim for ≥95% bundle compliance to meaningfully reduce SSI rates.
Skin Decolonisation
- Chlorhexidine gluconate (CHG) 4% shower/wash — night before AND morning of surgery
- Ensure patient rinses from neck down; avoid eyes and ears
- No rinse after CHG — allow to air dry for maximum residual activity
- Wipes (2% CHG) acceptable if shower not possible (immobile patients)
- Document CHG wash in pre-op nursing checklist
- Do NOT use bar soap after CHG wash — negates antimicrobial activity
Nasal Decolonisation (MRSA)
- Screen all elective surgical patients for S. aureus nasal carriage pre-op
- MRSA-positive: Mupirocin 2% nasal ointment TDS × 5 days pre-op
- MRSA-positive: CHG 4% wash daily × 5 days (body decolonisation)
- Vancomycin added to prophylaxis for known MRSA carriers
- MSSA-positive in high-risk procedures: consider mupirocin + CHG protocol
- Document decolonisation completion in pre-anaesthesia chart
Hair Removal
- Clippers ONLY — never use razors (micro-lacerations increase SSI risk ×2)
- Remove hair as close to surgery time as possible (ideally <2h pre-incision)
- Never shave the night before — increases bacterial colonisation risk
- If hair is not in surgical field — do NOT remove
- Use single-use clipper heads; disinfect reusable clippers between patients
Glycaemic Control — GCC Priority
GCC Context: Diabetes prevalence in GCC is 15–20% (world's highest). Hyperglycaemia impairs neutrophil function, wound angiogenesis and collagen synthesis. SSI risk doubles per 40 mg/dL rise above 200 mg/dL.
- HbA1c <8.5% required for elective surgery (optimise pre-op if possible)
- Target peri-operative blood glucose 140–180 mg/dL
- Glucose >200 mg/dL on day of surgery — consider postponing elective cases
- Insulin infusion protocol for major surgery (cardiac, orthopaedic)
- Monitor glucose every 1–2h intra-op and for 48h post-op
- Coordinate with endocrinology for poorly controlled DM patients
Antibiotic Prophylaxis — Timing & Selection
Critical Rule: Antibiotic must be administered within 60 minutes before skin incision (120 min for vancomycin/fluoroquinolones due to infusion time). Administration after incision provides NO benefit.
| Procedure Type | First-line Agent | MRSA Carrier / Allergy | Re-dosing Interval |
|---|---|---|---|
| Clean (cardiac, orthopaedic, vascular) | Cefazolin 2g IV (3g if >120kg) | Vancomycin 15–20 mg/kg IV | Every 4h (cefazolin) |
| Clean-contaminated (GI, biliary, gynaecology) | Cefazolin ± metronidazole | Vancomycin + metronidazole | Every 4h (cefazolin) |
| Colorectal | Cefazolin + metronidazole | Vancomycin + metronidazole | Every 4h |
| Urological | Cefazolin or TMP-SMX | Vancomycin | Every 4h |
| Neurosurgery | Cefazolin 2g IV | Vancomycin | Every 4h |
Re-dosing rule: Re-dose intra-operatively if procedure exceeds 2× the half-life of the antibiotic OR if significant blood loss (>1500 mL). Nursing must co-ordinate with anaesthetics and surgeon for timely re-dosing.
Nutritional Optimisation
- Malnutrition significantly impairs wound healing — assess all elective patients
- Use MUST score (Malnutrition Universal Screening Tool) pre-op
- Refer to dietitian if MUST ≥2 or BMI <18.5 kg/m²
- Pre-op carbohydrate loading (12.5% maltodextrin drink 400 mL) up to 2h pre-op
- Encourage protein intake ≥1.2 g/kg/day in weeks before surgery
- Zinc, Vitamin C and Vitamin A support wound healing — supplement if deficient
- Early enteral feeding post-op reduces SSI risk (gut barrier integrity)
Smoking Cessation
- Smoking impairs tissue perfusion, collagen synthesis and immune function
- SSI risk is 2–3× higher in active smokers
- Cessation ≥4 weeks before surgery is ideal for meaningful reduction
- Even short-term cessation (≥2 weeks) reduces respiratory complications
- Nicotine replacement therapy is appropriate pre-operatively
- Document smoking status and cessation counselling in nursing notes
- Referral to smoking cessation clinic for elective procedures
Pre-operative Bundle Checklist
Click items to track completion — saved in browser.
- CHG shower prescribed and documented (night before + morning of surgery)
- MRSA screening result reviewed — decolonisation protocol initiated if positive
- Hair removal plan: clippers only, within 2h of incision
- Pre-op blood glucose checked — within target (140–180 mg/dL)
- HbA1c reviewed and documented for diabetic patients
- Antibiotic prophylaxis prescribed — correct agent, dose, timing
- Antibiotic administered within 60 min of incision — confirmed
- Nutritional status assessed (MUST score documented)
- Smoking status documented — cessation advice provided
- Allergies verified against prophylaxis prescription
Intra-operative SSI prevention is a shared responsibility between the scrub nurse, circulating nurse, anaesthetic nurse, and surgeon. Strict adherence to aseptic technique and environmental controls are the cornerstones.
Surgical Hand Preparation (WHO)
Surgical hand scrub (antiseptic)
Chlorhexidine 4% or povidone-iodine: 3–5 min scrub to mid-forearm — all surfaces including subungual spaces
OR: Surgical hand rub (ABHR)
Alcohol-based hand rub 3-step technique: hands, forearms, then hands again — total ~2 min application time; allow to dry completely
Gowning
Sterile gown donned first; circulator ties back ties; gown changed if contaminated
Gloving
Closed gloving technique by scrub nurse; double-glove for high-risk procedures (orthopaedic, prolonged surgery); change outer glove if puncture suspected
Sterile Field Maintenance
- Establish sterile field immediately before use — never set up the night before
- Sterile field boundary must be visible and unambiguous at all times
- Non-scrubbed personnel remain ≥30 cm from sterile field
- Sterile items handed to scrub from above the table level
- Any item that falls below the sterile field table level is considered contaminated
- Draping: surgeon applies sterile surgical drapes in sequence — small to large
- Adhesive iodophor incise drapes (e.g. Ioban) for high-risk cases
- Opened items recorded on scrub count sheet
- No talking directly over the sterile field
Normothermia Maintenance — GCC Theatre Context
GCC Issue: Operating theatres in GCC hospitals are frequently kept very cold (<18°C). Patients in light surgical gowns are at high risk of inadvertent perioperative hypothermia (IPH), which increases SSI risk by up to 3× and impairs wound healing.
Pre-warming (30 min before induction)
- Forced air warming (FAW) blanket applied in pre-op area
- Warmed IV fluids for major surgery (>500 mL)
- Target core temperature >36.0°C before induction
Intra-operative (anaesthetic nursing role)
- Continuous temperature monitoring — oesophageal probe or bladder
- FAW underbody blanket maintained throughout procedure
- Warmed irrigation fluids (>37°C) for abdominal and thoracic cases
- Document temperature every 15 minutes on anaesthetic chart
- Alert surgeon + anaesthetist if core temperature <36°C
Instrument, Sponge & Needle Counts
- Count performed: initial (before procedure), before wound closure, and at skin closure
- Scrub nurse and circulator count together — each verbally confirming
- Any discrepancy requires: surgeon notification, field search, X-ray if unresolved
- Retained foreign body is a never event — counts documented in legal record
- Radiofrequency detection systems (SmartSponge) recommended for complex cases
- Needles counted by number — sharps bin placed where visible to scrub
Wound Irrigation & Haemostasis
- Copious warm saline irrigation reduces microbial load before closure
- Avoid cold irrigation — exacerbates IPH
- Dilute povidone-iodine (0.35%) irrigation considered for contaminated wounds
- Achieve meticulous haemostasis — haematoma is a culture medium for bacteria
- Eliminate dead space — obliterate with sutures or consider drain placement
- Diathermy use: minimum effective setting to prevent tissue necrosis
- Bipolar preferred near nerves and in neurosurgery/ophthalmic cases
Wound Closure — Nursing Role
| Closure Type | Indications | Nursing Action |
|---|---|---|
| Sutures (absorbable) | Deep layers, subcutaneous fat; contaminated wounds | Pass correct suture in sequence; record suture type on count sheet |
| Sutures (non-absorbable) | Skin — nylon, prolene for clean wounds | Document suture material and removal date in nursing notes |
| Staples | Scalp, trunk, extremity clean wounds; fast closure | Load stapler; staple remover available at 7–14 days; document count |
| Tissue glue (Dermabond) | Superficial, low-tension, dry wounds; paediatric | Keep field dry; apply three thin layers; do NOT use in moist wounds |
| Steri-strips | Support closure; small wounds; paediatric | Ensure skin dry; apply perpendicular to wound; overlap edges |
Theatre Wound Dressing Application
- First dressing applied in the sterile field by the scrub nurse before drape removal
- Use sterile technique throughout — gloves maintained until dressing secured
- Non-adherent primary contact layer (e.g. Mepore, Adaptic) applied first
- Absorbent secondary layer for wounds expected to exude (abdominal, orthopaedic)
- Secure with skin-friendly tape — avoid circumferential bandaging on limbs
- Label dressing with date and time; document in operative nursing notes
- NPWT (negative pressure wound therapy) applied in theatre for selected complex cases
WOUND Assessment Acronym
W
Wound Type
Surgical incision, traumatic, pressure, burns. Primary closure, secondary intention, tertiary/delayed. Document at every dressing change.
O
Observation of Wound Edges & Surrounding Tissue
Assess for erythema (beyond normal 2cm post-op margin), warmth, induration, oedema, maceration, dehiscence, tunnelling.
U
Underlying Tissue
Inspect base: healthy granulation (red/pink), slough (yellow), necrosis (black/brown), exposed tendon/bone/implant. Escalate if implant visible.
N
Nature of Exudate
Serous (clear, normal), serosanguineous (pink-tinged, normal early), haemosanguineous (red — blood), purulent (yellow/green/grey — infected). Quantify: scant/moderate/heavy.
D
Dimensions
Measure length × width in cm. For open wounds: also depth and any undermining. Serial measurements track healing progression. Use disposable measuring tape.
First Dressing Change — 48h Rule
- Leave intact theatre dressing for 48 hours if no soaking, no fever, no swelling
- Epithelial resurfacing begins in 24–48h; disruption increases infection risk
- First dressing change is an assessment opportunity — use WOUND acronym
- Strict aseptic technique: sterile gloves, sterile dressing pack, ANTT principles
- Remove old dressing gently — moisten if adhered; avoid stripping fragile skin
- Clean wound with sterile normal saline (0.9% NaCl) — no scrubbing
- Document wound appearance, exudate, dimensions in nursing notes
- Photograph wound with patient consent for continuity of care
Dressing Selection Guide
| Wound State | Recommended Dressing |
|---|---|
| Clean primary closure, dry | Non-adherent island dressing (Mepore, Primapore) |
| Lightly exuding | Foam (Mepilex, Allevyn) — 3-day change |
| Moderately to heavily exuding | Alginate (Kaltostat, Sorbsan) or Hydrofibre (Aquacel) |
| At-risk / colonised wound | Antimicrobial: iodine-cadexomer (Iodosorb) or silver (Aquacel Ag) |
| Sloughy wound | Hydrogel (IntraSite) for autolytic debridement |
| Necrotic wound | Hydrogel or surgical debridement — escalate to surgeon |
| Complex/high-risk/open | NPWT (VAC therapy) — see below |
Negative Pressure Wound Therapy (NPWT)
Indications
- Open/complex surgical wounds (laparostomy, dehiscence)
- High-risk primary closure (obese, diabetic, contaminated wound)
- Wounds with significant dead space
- Post-debridement to promote granulation
- Sternal wounds post-cardiac surgery
Nursing Management
- Check seal integrity every shift — air leak triggers alarm
- Record canister volume every shift — alert if >50 mL/h output
- Standard pressure: -125 mmHg continuous; lower for fragile tissue
- Change foam dressing every 48–72h (can extend to 7 days for prophylactic iNPWT)
- Irrigating NPWT (NPWTi): instil normal saline every 1–4h per protocol
- Document canister changes, output character, wound appearance
Drain Management
- Closed suction drains (e.g. Redivac, Blake) preferred over open drains
- Record drain output: volume and character every shift
- Criteria for removal: output <30 mL/24h for ≥2 days
- Milking/stripping drains only if prescribed — can increase suction trauma
- Keep drain site clean and dry — treat as separate sterile wound
- Drains left >5 days significantly increase infection risk — advocate for timely removal
- Biliary/urological drains: specialised removal protocols — surgical team decision
Patient & Family Education
- Teach wound care in patient's primary language — translation services in GCC
- Demonstrate dressing change using teach-back method before discharge
- Provide written discharge instructions on wound care, bathing, showering
- When to seek immediate medical attention: fever >38°C, increasing pain, redness, pus
- Bathing: shower allowed when wound dry and closed (usually 48h); no soaking baths
- Diet: high-protein foods post-discharge to support healing
- Activity restrictions specific to procedure (e.g. no lifting, driving)
- Follow-up appointment — wound check and suture/staple removal date
Time-sensitive: Early recognition and escalation of SSI reduces the risk of progression from superficial to deep infection, organ/space involvement, sepsis, and death. Never delay reporting suspected SSI to the surgical team.
Classic Signs of SSI
| Sign | Assessment | Note |
|---|---|---|
| Rubor (Redness) | Erythema extending >2 cm from wound edge | Normal erythema <2 cm for first 48h; beyond that is abnormal |
| Calor (Warmth) | Periwound area warm to touch compared to contralateral site | Always compare bilaterally |
| Tumor (Swelling) | Induration, oedema, fluctuance (indicates collection) | Fluctuance suggests abscess — do not probe; escalate to surgeon |
| Dolor (Pain) | Pain disproportionate to operative day or re-escalating after initial improvement | Pain should trend DOWN after day 3; any re-escalation is a red flag |
| Purulent discharge | Yellow, green, grey or foul-smelling exudate from wound or drain | Sanguineous discharge on day 1–2 is normal; purulence is never normal |
| Systemic fever | Temperature >38.5°C after day 2 (not explained by another source) | Rule out atelectasis (day 1–2), UTI, line infection before attributing to SSI |
Wound Swab Technique (Levine Method)
1. Prepare the wound
Clean wound with sterile normal saline first — remove surface debris and exudate
2. Select swab site
Target the most viable, granulating tissue — not surface slough, pus, or necrosis
3. Rotating pressure technique
Press swab firmly on 1 cm² area; rotate 360° while moving across the area in a zigzag for 5 seconds — applies sufficient pressure to sample deeper tissue fluid
4. Process immediately
Place in transport medium; deliver to microbiology within 2h; note: antibiotic patient — document current antibiotics on request form
5. Document and communicate
Record swab site, time, clinical findings in nursing notes; inform medical team of pending result
MRSA SSI Protocol
All suspected or confirmed MRSA SSI patients require immediate isolation. Failure to implement contact precautions risks outbreak in the surgical ward.
Isolation & Contact Precautions
- Single room with en-suite bathroom if possible
- Contact precautions: gloves and apron/gown for all patient contact
- Dedicated equipment (stethoscope, BP cuff, thermometer) for this patient
- Door signage per hospital MRSA policy
- Visitors educated on hand hygiene and contact precautions
- Notify infection control nurse immediately
Treatment & Decolonisation
- Vancomycin IV (target trough 15–20 µg/mL) or daptomycin if renal impairment
- Continue CHG body wash daily and mupirocin nasal ointment TDS
- Wound dressing: antimicrobial (silver or iodine-based)
- Repeat MRSA swabs post-treatment (nose, wound, axilla, groin)
- 3 consecutive negative screens required before clearing isolation
- Antibiotic duration: minimum 2 weeks for deep SSI; longer for implant infection
Wound Dehiscence Management
- Superficial dehiscence: cleanse, apply secondary wound closure strips or foam dressing
- Deep dehiscence: cover wound with moist sterile dressing, call surgical team urgently
- Evisceration (bowel protrudes): cover with moist sterile towel, keep supine, emergency OR
- Do NOT attempt to push eviscerated bowel back — risk of further injury
- IV access, fluid resuscitation, NBM status, anaesthetic team notification
- Document time of discovery, appearance, any precipitating factor (coughing, vomiting)
- Consider NPWT for bridging management pending return to theatre
Deep SSI / Organ-Space SSI
- Suspect when: fever persists beyond day 5, wound pain worsens, no superficial source found
- Blood cultures × 2 sets before starting antibiotics (if clinically stable)
- Imaging: CT scan with IV contrast is the gold standard for intra-abdominal collections
- Ultrasound: bedside tool for superficial or pelvic collections
- Radiological drainage (IR-guided) preferred over open drainage when feasible
- Return to theatre indications: generalised peritonitis, failed IR drainage, anastomotic leak
- Nursing: strict fluid balance, sepsis bundle, escalation to critical care if organ dysfunction
Empirical Antibiotic Initiation
Empirical antibiotics should be started after wound swab and blood cultures are obtained. Adjust based on culture results (de-escalate per antimicrobial stewardship principles).
| Severity | Empirical Regimen | Duration |
|---|---|---|
| Superficial SSI — mild | Flucloxacillin 500 mg PO QDS or co-amoxiclav 625 mg TDS | 5–7 days |
| Superficial SSI — MRSA suspected | Trimethoprim-sulfamethoxazole or doxycycline (MRSA-sensitive strains) | 7–10 days |
| Deep SSI — moderate | Cefazolin IV ± metronidazole | 10–14 days |
| Deep/Organ SSI — severe | Piperacillin-tazobactam ± vancomycin (MRSA cover) | 14–28 days (source control dependent) |
| Implant-related SSI | Vancomycin IV + rifampicin (biofilm penetration); ID team input essential | ≥6 weeks for implant retention |
GCC-Specific Nursing Practice: Nurses working in GCC must adapt SSI prevention strategies to a unique epidemiological and cultural context. The following considerations are specific to Saudi Arabia, UAE, Kuwait, Qatar, Bahrain, and Oman.
Diabetes — GCC's Biggest SSI Challenge
GCC countries have the highest diabetes prevalence in the world (15–20% adults). Saudi Arabia alone has ~7 million diabetics. SSI in diabetics is 2–4× more common, heals more slowly, and more frequently involves MRSA.
- Screen all GCC surgical patients for diabetes — undiagnosed DM is common
- Peri-operative glucose monitoring: every 1–2h for known diabetics
- Insulin-sliding scale or infusion protocol for all major surgery
- Diabetic foot surgery: highest SSI risk group in GCC — multidisciplinary wound teams
- HbA1c optimisation: refer to endocrinology 4–8 weeks before elective surgery
- Post-discharge: ensure patient has glucometer and knows target range for wound healing
- Community health nurses: vital for post-discharge glucose monitoring in GCC home settings
Obesity in GCC
GCC obesity rates: 30–40% of adults (WHO data). Adipose tissue is poorly vascularised and hypoxic — ideal environment for anaerobic bacteria. SSI risk increases 30–40% per 5-unit BMI increase above 30.
- Use higher cefazolin dose: 3g IV for patients >120 kg
- Apply incisional NPWT prophylactically for BMI >40 + orthopaedic/abdominal surgery
- Skin fold moisture management pre-op: CHG wipes under skin folds
- Bariatric-specific theatre positioning: appropriate table and padding
- Subcutaneous drain placement for deep adipose tissue closure
- Extended prophylaxis duration not recommended — increases resistance risk
MRSA Landscape in GCC
- MRSA rates vary widely: 20–40% of S. aureus isolates in some GCC hospitals
- Community-acquired MRSA (CA-MRSA) strains circulating in GCC — different from HA-MRSA
- Universal pre-op MRSA screening recommended for elective surgical patients
- Healthcare worker MRSA screening important — carrier nurses transmit to wounds
- Vancomycin MIC creep documented in GCC ICUs — daptomycin may be needed
- Infection control must review SSI microbiological data monthly for trends
- Antimicrobial stewardship programmes (ASP) now mandated in JCI-accredited GCC hospitals
Water & Home Wound Care in GCC
- Tap water quality in GCC is generally good — clean water for wound irrigation at home
- Boiled water (cooled) or bottled water acceptable for wound irrigation if prescribed
- Humidity: some GCC areas have high humidity — increases wound maceration risk
- Patient preference: strong preference for hospital-based wound care over home care
- Outpatient wound clinics in GCC hospitals are heavily utilised — reduce SSI readmissions
- Home care nursing services available through MOH and private providers — refer when appropriate
- Educate patients: sterile-packaged saline for home wound cleaning — widely available in GCC pharmacies
Ramadan & Post-operative Wound Care
Many GCC patients elect to defer surgery until after Ramadan or may insist on fasting during recovery. Nurses must be culturally sensitive while ensuring patient safety and wound healing.
Fasting Risks During Recovery
- Dehydration impairs tissue perfusion and wound oxygenation
- Reduced caloric intake slows collagen synthesis and epithelialisation
- Hyperglycaemia risk at Iftar (large rapid meal) then hypoglycaemia at Suhoor
- Medication timing disruption (oral antibiotics, anticoagulants)
Nursing Approach
- Consult with Islamic scholar or hospital chaplain if patient has doubts about fasting during illness (Islam permits breaking fast during illness)
- Encourage adequate oral hydration during non-fasting hours
- Adjust antibiotic and glucose monitoring schedule to Iftar/Suhoor times
- Emphasise high-protein Iftar meals to support wound healing
- Close monitoring for wound infection during Ramadan recovery period
JCI SSI Bundle Compliance & Antimicrobial Stewardship
JCI SSI Bundle Metrics (IPSG 5)
- Prophylactic antibiotic within 60 min of incision: target >95%
- Correct antibiotic selection per hospital formulary: target 100%
- Antibiotic discontinuation within 24h post-op: target >90%
- Pre-op blood glucose control in DM patients: documented
- Clippers used (not razors) documented: target 100%
- SSI rates by procedure type: quarterly reporting to quality committee
Antimicrobial Stewardship Nursing Role
- ASP is growing priority across GCC — antibiotic resistance accelerating
- Nurse advocates for IV-to-oral switch when patient clinically improving
- Remind prescribers: prophylaxis discontinuation at 24h — prolonged courses increase resistance
- Flag unexplained antibiotic continuations to pharmacist and ASP team
- Document culture results and communicate to prescriber promptly (de-escalation)
- Report antibiotic-resistant organisms to infection control within 24h
Interactive SSI Risk Calculator
Enter patient parameters to generate a personalised SSI risk estimate and recommended care bundle.