Purpose:

It is Sunnybrook’s intent to verify that the care of surgical incisions postoperatively is in accordance with Sunnybrook policies in an effort to reduce the incidence of surgical site infections (SSIs).

Definitions:

Primary intention = wound closure immediately following the injury and prior to the formationof granulation tissue

Saturated operative dressing = where the drainage from the post-surgical wound soaks through all dressings applied in the operating room (OR), before time of ordered dressing reduction. (Usually Post-operative Day 0 or Day 1).

Open and draining incision = A surgical wound where the margins of the incision have not sealed completely and the wound is draining serous, serosanginous or purulent drainage.

Clean and Intact incision = A surgical wound where the margins of the incision have sealed and no or minimal drainage is present. (Usually occurs after 24-48h post-operatively).

Abbreviations: HH = hand hygiene (either alcohol-based hand rub OR soap & water), PPE= Personal Protective Equipment, HCW = Health care worker, MOG = glove use without hand hygiene

Department/Area to be audited: ______

Type of wound closure / □Primary intention □Secondary intention □Vacuum Assisted Closure (VAC)
How old is the wound? / □<24 hrs □Post-op Day 1 □Post-op Day 2 □>48 hrs
Protocol / A. Dressing Change using minimal barrier aseptic technique / B. Dressing change using maximal barrier aseptic technique
Indication / □ Clean Intact Incision / □ Initial Post-op Dressing Change
□ Saturated Operative Dressing
□ Open & Draining incisions
Equipment
(check if present) / A. Minimal / B. Maximal
□ Clean gloves
□ Sterile gloves
□ Waste bag for used dressings / □ 50ml sterile normal saline irrigation solution
□Dressing supplies as needed / □ Clean gloves
□ Sterile gloves
□ Mask
□Gown (if needed) / □ Waste bag for used dressings
□ 50ml sterile normal saline irrigation solution / □ Dressing Tray
□ Sterile dressing supplies as needed
Preparation
Was the patient offered analgesia? / □YES □NO
Has privacy been ensured? / □YES □NO
Has all equipment been collected and placed on a clean surface? / □YES □NO
Has HH been performed before opening dressing packages? / □YES □NO □Yes, with reminder
Precautions / A. Minimal / B. Maximal
Is appropriate PPE being worn? / □YES □NO
(clean gloves only) / □YES □NO
(mask, gown needed if soiling of clothes is likely, and clean gloves)
Was PPE applied in proper sequence? (HH, mask, gown, gloves) / N/A / □YES □NO
Was the sterile field maintained throughout the procedure? / □YES □NO
Cleaning
Is the HCW using sterile gloves? / □YES □NO □Yes, with reminder
Is the cleansing solution being used normal saline (as per policy)? If no, state other. / □YES □NO Other:
Is the wound being cleaned from the incision line outwards (clean to dirty) in one direction only? / □YES □NO □Yes, with reminder
Is each cleaning pad used only once? / □YES □NO □Yes, with reminder
Is a culture swab being taken? / □YES □NO
If yes, has the area first been cleaned of any frank pus? / □YES □NO □Yes, with reminder □ N/A
Was clean tape used to secure the new dressing? (i.e. from the trolley, not a pocket) / □YES □NO □Yes, with reminder □ N/A
Have the wound & surgical dressing been kept out of contact with tap water? / □YES □NO
Disposal
Were dressings disposed of properly?
(minimally contaminated dressings in the regular garbage; heavily contaminated [i.e. with blood] dressings in yellow bags) / □YES □NO □Yes, with reminder
Was PPE removed & disposed of in the proper sequence: gloves & gown (HH) then mask (HH)? / □YES □NO □Yes, with reminder □ N/A
Hand Hygiene
Was HH performed:
Y = yes
N = no
WR = yes, with reminder
MOG = glove change without HH / _____ Before donning clean gloves/
removing soiled dressing / _____ After removing soiled dressing & gloves/before donning sterile gloves
_____ After applying new dressing & removing sterile gloves / _____ After any direct contact with the surgical site
Documentation / A. Minimal / B. Maximal
Has the wound been assessed, and the following findings documented: / □ Condition of the wound
□ Pain & comfort of patient / □ Condition of the wound
□ Pain & comfort of patient
□ Drainage – amount, type (serous, sanguineous, etc.), colour, odour
If the patient is being discharged, have they been given wound care instructions? If yes, what type? / □YES □NO □ N/A (not being discharged)
(Check all that apply) □Verbal □ Hand-written □ Pamphlet
Level of Knowledge
Has the staff member ever received education/ training surrounding wound care? / □YES □NO
Is the staff member aware of SB’s policy for post-op incision care? / □YES □NO

Source: Postoperative Incision Care (Policy CLS-0032); Last revised August 2008.Available at: http://sunnynet.ca//Default.aspx?cid=100798&lang

Auditor Signature: Date:

______(MM/DD/YYYY) ______/ ______/______

Print name: ______Dept: ______Position: ______

Checklist for Postoperative Incision Care Audit

1