7 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • O C T O B E R 2 0 1 8
When combined with other essential steps, wound irrigation is an
easy and economical way to prevent surgical site infections, but no
one can say for certain which way is best to wash out a wound during
surgery. Unlike many other SSI prevention efforts, there are no offi-
cial practice guidelines or recommendations for irrigation. As a
result, irrigation practices can vary widely when it comes to delivery
method, volume and solution additives.
We standardized our irrigation practices for colon resections. Our pro-
tocol includes a well-defined system of irrigation combined with antibi-
otics. For intraabdominal irrigation, we rely on a combination of saline
mixed with clindamycin and gentamicin antibiotics. The amount of irriga-
tion depends on whether the patient is having open or laparoscopic sur-
gery and wound class. This simple chart we created below makes it easy
to determine the irrigation amount.
But irrigation is only one part of the process. We must complete
each step of our closing protocol for the process to work. That proto-
col includes:
• wound protectors;
• a closing tray with a set of 15 instruments to close the fascia up
to the skin — brought out only after we've removed all the items
used during the surgery, such as bovies and suction instruments;
• glove and gown changing at closing; and
• irrigation (often with antibiotics and based on wound class.)
We also changed some of the practices to which our surgeons had
grown accustomed. For example, instead of placing instruments
under the drapes when the surgical site is "squared off," we use utili-
ty drapes because the closing tray altered our counting policy.
Our Bundled Closing Protocol for Colon Resections
IRRIGATION + ANTIBIOTICS
