🛡️ Intraoperative Surgical Site Infection (SSI) Prevention [Neurosurgery Wiki]

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====== 🛡️ Intraoperative Surgical Site Infection (SSI) Prevention ======

The **intraoperative period** is critical for maintaining sterility and minimizing the risk of **surgical site infections (SSIs)**. Strict adherence to infection prevention measures ensures better outcomes.

===== 🎯 Objectives =====
  * Maintain a **sterile field** throughout the procedure
  * Prevent **microbial contamination** of surgical instruments and wounds
  * Optimize **patient and environmental factors** intraoperatively

===== 🔍 Key Intraoperative Measures =====

==== 🧼 1. Surgical Hand Antisepsis ====
  * Perform with **chlorhexidine or povidone-iodine**-based scrub
  * Use alcohol-based hand rubs if preferred
  * Include proper **gowning and gloving**

==== 🩺 2. Skin Antisepsis and Draping ====
  * Ensure **adequate drying** of antiseptic before draping
  * Use **sterile, fluid-impermeable drapes**
  * Re-prep site if contamination occurs

==== 💉 3. Antibiotic Redosing (If Needed) ====
  * Re-administer prophylactic antibiotics:
    - After 2–4 hours (depending on agent)
    - In case of **major blood loss** (>1500 mL)

==== 🌬 4. Environmental Control ====
  * Limit **door openings and personnel traffic**
  * Maintain **positive-pressure ventilation**
  * Use **HEPA-filtered airflow** (especially for implants)

==== 🛠 5. Aseptic Technique and Instrument Handling ====
  * Use **sterile instruments** and **sterile fields**
  * Avoid reuse of instruments for deep vs superficial tissues
  * Replace contaminated gloves/instruments immediately

==== 🧪 6. Hemostasis and Wound Care ====
  * Avoid hematoma formation
  * Minimize tissue trauma and devitalization
  * Irrigate wound with **sterile saline** before closure

==== 👨‍⚕️ 7. Implant Handling (if applicable) ====
  * Use **antibiotic-coated implants** when indicated
  * Minimize exposure time of implants before placement
  * Avoid contact with non-sterile surfaces

===== 🧠 Special Notes for Neurosurgery =====
  * Maintain **CSF integrity** (avoid leaks)
  * Use **antibiotic-impregnated catheters** for EVD/shunts
  * Avoid excessive **dural manipulation or retraction**
  * Consider **surgical field irrigation with vancomycin** (case-dependent)

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{{tag:infection_prevention intraoperative SSI aseptic_technique surgery neurosurgery}}