before colon surgery had lower infection risks. We never would have hit
on this practice if we didn't get all departments involved in our infec-
tion prevention efforts and instead continued to work independently
from one another.
• Pre-op bathing. Finally, patients must do a full-body chlorhexidine
gluconate (CHG) shower the night before surgery as well as the morn-
ing of the procedure. We use clippers to remove hair — to avoid the
microscopic nicks from shaving that can increase infection risks — in
the pre-op area only, not the OR.
2. During surgery
Our detailed efforts to eliminate infections continue in the OR:
• Antibiotic prophylaxis. Within 60 minutes of the skin incision,
patients receive cefoxitin or, if the patient has a beta-lactam allergy,
ciprofloxacin 400mg IV plus metronidazole 500mg IV. An antibiotic re-
dose occurs every 3 hours during extended cases.
• Maintaining normothermia. We set the OR ambient temp between
72°F and 75°F. We apply forced-air warming to patients and, if the sur-
gery is longer than 2 hours, we give warm IV fluids.
• Blood glucose monitoring. During surgery, anesthesia providers
maintain blood glucose levels of less than 150 mg/dL in patients with a
known diabetes diagnosis. On the rare occasion that a patient requires
an insulin infusion or multiple insulin doses, we administer a basic
metabolic panel (BMP) test before the patient's departure from the OR.
• Limited foot traffic. In addition to making sure needed supplies
and equipment are in ORs before cases begin, we've hung a big sign
outside of our OR doors that reminds staff to place a phone call into
the room before entering. You'd be surprised at just how effective this
sign is at limiting unnecessary entries. Before it was there, staff would
pop in to ask if the surgical team needed anything or to see if it was
time for someone to go on break. Now, these non-essential questions
