Background
Methods for the development of recommendations
Recommendations | Key actions for patients |
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1. Staphylococcus aureus screening and decolonization | For high risk surgery, nasal screening for methicillin-sensitive S. aureus (MSSA) or methicillin-resistant S. aureus (MRSA) carriage is recommended |
Decolonization treatment with mupirocin 2% ointment with or without a combination of chlorhexidine gluconate body wash prior to surgery is needed for nasal carriage of MSSA or MRSA | |
Apply decolonization treatment at least the night and the morning before your surgery Decolonization treatment for 3–5 days before the surgery if possible | |
2. Smoking | Inform your doctor about your smoking history before surgery |
Quit smoking 4 weeks or longer before your surgery | |
3. Hair removal | Shaving is strongly discouraged |
Do not remove hair at the site of the planned incision when at home Hair should only be removed with an electrical clipper | |
4. Hand hygiene | Clean your hands before eating a meal; after visiting the toilet or using commode/urinal; before and after touching your drip (IV line) or drainage bag/tube |
Visitors should not touch your wound or dressings | |
Speak up if you do not see HCWs clean their hands | |
5. Body temperature | Ask about the procedures followed to keep you warm throughout surgery |
Take a hot shower shortly before the surgery | |
Avoid “cooling down” | |
Ask for extra blankets to keep yourself warm during transportation | |
Speak up, if you feel cold before or after surgery and ask for a blanket | |
6. Preoperative showering and bathing | Make sure your skin is clean before surgery |
Shower or bathe (full body) with either soap (antimicrobial or non-antimicrobial) on the night before and/or in the morning of the surgery | |
7. Diabetes mellitus | See your doctor at least one month before your scheduled surgery |
Maintain stable blood glucose levels before, during and after surgery | |
Inform HCWs about your routine insulin regime | |
8. Wound care after surgery | The wound dressing should be kept in place for 48 h after surgery |
If change of dressing is necessary, this should be done under a clean technique | |
Ensure that HCWs clean hands immediately before changing your dressing | |
Visitors should not touch your wound or the dressing when visiting you | |
Make sure you know and understand how to care for your wound before leaving the hospital | |
Report any redness, pain, swelling or fever to HCWs | |
9. Multidrug-resistant organism risk (MDRO) | Inform HCWs about any travel history or previous recent hospitalisation |
Inform of any known carriage of any MDRO such as MRSA, Extended Spectrum β-Lactamase (ESBL) producing or Carbapenem-resistant Enterobacteriaceae (CRE) |
Education opportunities to improve patient engagement
Healthcare workers’ role to encourage patient engagement
Recommendation 1: Staphylococcus aureus screening and decolonization
What can the patient do?
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If you are undergoing high risk surgery including cardiothoracic and orthopedic surgery ask your healthcare worker for a nasal screening test to identify methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA) carriage
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If you are a nasal carrier of MSSA or MRSA you should receive decolonization treatment with intranasal applications of mupirocin 2% ointment with or without a combination of chlorhexidine gluconate (CHG) antiseptic body wash prior to surgery
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The treatment should be applied at least the night and the morning before your surgery. If possible you should receive decolonization treatment for 3–5 days before the surgery. In this case, the decolonization treatment can be done at home and you should be provided with information or a patient information leaflet on the correct use of the treatment application method.
Rationale
Recommendation 2: Smoking
What can the patient do?
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Inform your doctor about your smoking history well in advance prior to your surgery
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Quit smoking 4 weeks or longer before your surgery. Ask for nicotine replacement to help you stop smoking at least temporarily
Rationale
Recommendation 3: Hair removal
What can the patient do?
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At home, do not remove hair at the site of the planned incision (even if asked to do so). The skin may experience microscopic cuts and abrasions that microorganisms can enter and colonize these cuts. If you are shaving on a regular basis you will need to stop shaving near the surgical area at least five days before your surgery to prevent superficial infections
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While being in the hospital, ask the healthcare worker in charge of you, if any hair removal is deemed necessary. If you have local anesthesia or if someone wants to remove hair at the planned incision site using a razor, speak up. Shaving is strongly discouraged. If necessary, hair should only be removed with an electrical clipper [29]
Rationale
Recommendation 4: Hand hygiene
What can the patient do?
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Clean your hands by using an alcohol-based hand rub or, if your hands are visibly dirty, soap and water.
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before eating a meal
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after visiting the bathroom or using commode/urinal
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before and after touching your wound or wound dressing
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before and after touching your drip (IV line) or drainage bag/tube
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Make sure that healthcare workers clean their hands before assessing your wound, preferably with an alcohol-based hand rub solution
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Speak up if you do not see healthcare worker clean their hands before touching you
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Visitors should not touch your wound or dressings. If they need to be involved in wound care they should follow the same preventive measures as healthcare workers
Rationale
Recommendation 5: Body temperature
What can the patient do?
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It is important that you do not cool down before and during the surgical procedure
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Ask your doctor or nurse about the procedures followed to keep you warm throughout surgery
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Take a hot shower shortly before the surgery is scheduled and stay under the cover after your shower, so as to preserve warm body temperature
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Avoid “cooling down” and do not put on the surgical gown and stay uncovered long before the surgery commences
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Ask for extra blankets to keep yourself warm during transportation from the ward to and from the operating room
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Speak up, if you feel cold before or after surgery and ask for a blanket
Rationale
Recommendation 6: Preoperative showering and bathing
What can the patient do?
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Make sure your skin is clean before you are due for surgery
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Shower or bathe (full body) with either soap (antimicrobial or non-antimicrobial) or an antiseptic agent on the night before and/or in the morning of the day you are scheduled for surgery
Rationale
Recommendation 7: Diabetes mellitus
What can the patient do?
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If you have diabetes see your doctor at least one month before your scheduled surgery
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It is crucial to maintain stable blood glucose levels before, during and after surgery
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When hospitalised inform your doctor or nurse about your routine insulin regime
Rationale
Recommendation 8: Wound care after surgery
What can the patient do?
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The wound dressing should be kept in place for 48 h after surgery unless indications such as bleeding/exudate or abnormal pain are present
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If there is excess wound leakage and a change of dressing is necessary, this should be done under a clean technique (aseptic technique)
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Ensure that healthcare worker performs hand hygiene (clean hands) and puts gloves on immediately before changing your dressing
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Visitors should not touch your wound or the dressing when visiting you. If they need to help, they need to follow the mentioned infection prevention measures.
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Make sure you know and understand how to care for your wound before leaving the hospital
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If any symptoms of wound infection are present (redness, pain, swelling, fever) inform your doctor or nurse
Rationale
Recommendation 9: Multidrug-resistant organism (MDRO) risk
What can the patient do?
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About your travel history within the last year or previous recent hospitalisation abroad, in particular if you have been recently hospitalised in countries within Southern and Eastern Europe, Middle East and North Africa (since these countries are recognized as high risk for MDRO)
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Known carriage of any MDRO such as MRSA, Extended Spectrum β-Lactamase (ESBL) producing or Carbapenem-resistant Enterobacteriaceae (CRE)