Online Surgical Performance and Complications Tracking for O&G Surgeons, By O&G Surgeons

Interventions to reduce Surgical Site Infections in gynaecological surgery

Surgical site infections (SSIs) are a patient safety priority with recent initiatives introduced by the Centres for Medicaid and Medicare Services and the Joint Commission on the Accreditation of Healthcare Organisations.

SSIs are common and costly, occurring in approximately 2% to 5% of all patients undergoing gynaecological surgery. Steiner and Strand (2017) in the American Journal of Obstetrics and Gynaecology review predictive factors of SSIs and the evidence in obstetrics and gynaecology. Here we summarise their findings:


Preoperative factors altering the risk of SSI

  • Bathing or showering with an antiseptic skinwash: It is good clinical practice for patients to bathe or shower prior to surgery. A recent review found no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products to reduce the risk of SSIs. Either plain soap or an antimicrobial soap may be equally effective.
  • Hair removal: A Cochrane review compared hair removal vs no hair removal and found no statistically significant difference in SSI rates. There was a greater risk of SSI when shaving compared to clipping hair. There was no difference between hair removal the day before surgery or on the day of surgery.
  • Glycaemic control: tight glycaemic control is beneficial in reducing SSI rates in patients with and without diabetes. Patients without diabetes can still be susceptible to ‘stress hyperglycaemia’.
  • Prophylactic antibiotics: preoperative antibiotic prophylaxis is the current standard of care for hysterectomies.

Intraoperative factors

  • Abdominal/vaginal preparation. For skin antisepsis, chlorhexidine-alcohol-based skin preparation is superior to Betadine. Decreasing bacterial counts in the vagina reduces SSI risk (chlorhexidine in concentrations of 4% or less).
  • Increased operative time consistently has been shown to increase SSI. This is potentially due to temperature regulation, inflammation, and anaesthesia management.
  • Maintaining normal body temperature: Evidence strongly recommends maintenance of normothermia.

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