Surgical Site Infection Prevention Bundle Checklist
Implement evidence-based surgical site infection prevention measures including appropriate antibiotic prophylaxis, glucose control, and perioperative normothermia.
- Industry: Healthcare
- Frequency: Every surgical procedure
- Estimated Time: 10-15 minutes
- Role: Surgical Team
- Total Items: 49
- Compliance: CDC SSI Prevention, SCIP Measures, Joint Commission NPSG
Preoperative Preparation
Patient preparation
- Preoperative shower with antiseptic soap?
- If hair removal needed, clippers used (not razor)?
- MRSA nasal screening performed (if indicated)?
- Decolonization performed if MRSA positive?
Antibiotic Prophylaxis
Appropriate antibiotic use
- Prophylactic antibiotic indicated for procedure?
- Correct antibiotic selected per guidelines?
- Antibiotic given within 60 min before incision?
- Weight-based dosing used?
- Redosing performed if procedure prolonged?
- Prophylaxis discontinued within 24 hours?
Glucose Control
Blood glucose management
- Perioperative glucose monitored?
- Glucose maintained <180 mg/dL?
- Insulin protocol used if needed?
Perioperative Normothermia
Temperature management
- Temperature monitored intraoperatively?
- Warming devices used?
- Normothermia (>35.5°C) maintained?
Surgical Skin Preparation
Skin antisepsis
- Chlorhexidine-alcohol used (unless contraindicated)?
- Adequate dry time allowed?
- Skin prep documented?
Postoperative Wound Care
Wound management
- Sterile dressing applied?
- Wound care instructions provided?
- SSI surveillance plan in place?
Pre-Assessment Information
Initial assessment documentation and patient/facility identification
- Assessor Name / Credentials
- Assessment Date
- Department / Unit
- Assessment Type (Routine/Annual/Complaint)
- Previous assessment findings reviewed?
Infection Prevention & Control
Verify infection control practices per CDC and Joint Commission standards
- Hand hygiene compliance observed?
- Appropriate PPE available and properly used?
- Isolation precautions properly implemented?
- Sharps containers available and not overfilled?
- High-touch surfaces properly disinfected?
Patient Safety & Identification
Verify patient safety protocols and identification procedures
- Two patient identifiers used before procedures?
- Fall risk assessment completed?
- Call light within patient reach?
- Bed in lowest position with brakes locked?
Medication Safety & Management
Verify medication handling and administration practices
- Medications stored securely and at proper temperature?
- Controlled substances properly secured and counted?
- No expired medications in stock?
- High-alert medications properly labeled?
Environment of Care & Safety
Verify facility environment meets safety standards
- Fire exits clear and unobstructed?
- Emergency equipment functional and accessible?
- Spill kits available and stocked?
- Electrical cords and outlets in safe condition?
Documentation & Regulatory Compliance
Complete assessment documentation and ensure regulatory compliance
- All findings documented with evidence?
- Corrective actions assigned with timeline?
- Staff education provided on identified issues?
- Assessor Signature
- Additional Observations
Related Healthcare Checklists
- Infection Control Isolation Precautions Checklist
- Hand Hygiene Compliance Audit Checklist
- Environmental Services Patient Room Cleaning Checklist
- Healthcare Worker Exposure Follow-Up Checklist
- VTE Prophylaxis Assessment Checklist
- Patient Handoff SBAR Communication Checklist
- Patient Restraint Assessment & Monitoring Checklist
- Medication Administration Safety Checklist