1 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 9
moved closer to zero infections.
1. Before surgery
We begin to address these factors
as soon as we connect with
patients:
• Smoking cessation. We make
it a priority to get smokers to kick
the habit at least 30 days before
surgery by meeting with them and
explaining exactly why going
smoke-free is critical (research
shows it reduces the risk of SSIs
and leads to faster wound healing).
We ask, "What do you need to stop
smoking? The patch? Nicorette?"
Then, we make it happen.
• Glucose control. Diabetes and
high blood sugar are also linked to higher infection rates, so we work
to normalize serum glucose levels for all patients.
For diabetics, we want to get HbA1c to less than 7% before surgery
whenever possible. Again, simply having a frank conversation about
why this is so important is usually enough to get even the non-compli-
ant patients on board.
We identify and treat any infections that are remote to the surgery
site, such as UTIs, before the day of surgery.
• Early antibiotics. We prescribe patients either 1g of neomycin plus
1g of erythromycin or 3 doses of 1g of metronidazole to take in the
afternoon and evening before surgery. This protocol came directly from
our multidisciplinary meetings when a surgeon cited current literature,
which shows patients who take oral antibiotics the day and evening
• CLOSED-DOOR SESSION Preparing equipment and sup-
plies needed for surgery ensures traffic into and out of the OR
is kept to a minimum during the surgery.
