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

**Surgical site infections (SSIs)** are among the most common healthcare-associated infections and can significantly impact patient outcomes. A structured **preoperative prevention strategy** is essential to reduce SSI risk.

===== 🎯 Objectives =====
  * Minimize bacterial load at and around the surgical site
  * Optimize patient factors that influence immune response
  * Ensure aseptic conditions during the entire perioperative period

===== 🔍 Key Preoperative Measures =====

==== 🧼 1. Patient Skin Preparation ====
  * **Preoperative bathing** with antiseptic agents (e.g., chlorhexidine) the night before and morning of surgery
  * Emphasize attention to areas near the incision site

==== ✂️ 2. Hair Removal ====
  * Only if necessary
  * Use **clippers** (not razors)
  * Perform **immediately before surgery**

==== 💉 3. Antimicrobial Prophylaxis ====
  * Administer appropriate antibiotic **within 60 minutes** before incision
  * Selection based on:
    - Type of procedure
    - Local antibiogram
    - Patient allergies
  * Re-dose if surgery exceeds 2–4 hours or in cases of major blood loss

==== 🧴 4. Surgical Site Antisepsis ====
  * Apply **alcohol-based antiseptic** (e.g., CHG-alcohol) unless contraindicated
  * Allow sufficient **drying time**
  * Avoid contamination after application

==== 🧪 5. Control of Patient Risk Factors ====
  * Optimize **glucose control** (target blood glucose <180 mg/dL)
  * Treat remote **infections** prior to elective surgery
  * Address **anemia**, **malnutrition**, **smoking**, or **obesity** preoperatively
  * Screen for **Staphylococcus aureus** nasal carriage (select cases)

==== 🏥 6. Operating Room Preparation ====
  * Maintain **air quality** (e.g., laminar airflow for implants)
  * Minimize traffic and door openings
  * Ensure availability of **sterile equipment and drapes**

===== 📋 Patient Education =====
  * Instruction on **pre-op hygiene**, fasting, and medication management
  * Reinforce **not to shave** at home
  * Inform about SSI symptoms and postoperative care

===== 🧠 In Neurosurgery =====
  * High-risk procedures (e.g., craniotomy, spinal instrumentation)
  * Consider antibiotic-impregnated materials (e.g., EVD, shunts)
  * Avoid CSF leak and ensure watertight dural closure