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Preventing health care associated infections 153

6.5.4 Procedural interventions
(1) Several procedural interventions are used to inhibit the spread of in-
fections in the health-care setting. These include use of antimicro-
bials, prophylactic antibiotics, surgical clippers, postoperative glucose
control, postoperative normothermia, WHO Safe Surgery Saves Lives
campaign, and CDCs SSI Guidelines. Each of these interventions is
intended to address different aspects of HAI prevention.
(2) There are several ways to prevent microorganisms from being able to
move or from encountering a potential host even when the microor-
ganisms are present. Use of PPE can be used to prevent contact with
microorganisms. Gloves can be used to prevent picking up organisms
on the hands. For respiratory droplets, mucosal surfaces can be pro-
tected from having contact with droplets by using masks, goggles, and
face shields. Airborne microorganisms can be filtered out of the air
with HEPA filters and PPE can be used to prevent contact with these
organisms. Common vehicle transmission can be addressed by deter-
mining the common vehicle that is causing an infection and then elim-
inating that vehicle. It is also possible through cleaning, disinfection,
and sterilization of medical devices to prevent surgical instruments
and endoscopes from becoming common vehicles for transmitting a
disease.
(3) Antimicrobials
Antimicrobials are agents that either kill or inhibit the growth of mi-
croorganisms. These agents can be classified by the type of microor-
ganism they primarily act against. Antibiotics control bacteria while
antifungals control fungi. Antimicrobial chemotherapy uses antimicro-
bial medicines to treat infection and antimicrobial prophylaxis uses an-
timicrobial medicines to prevent infection. Use of antimicrobial agents
has been common practice for at least 2000 years.
(4) Surgical Clippers
It is generally recommended that hair removal should not be per-
formed prior to surgery. If hair removal is necessary, clippers and not
a razor should be used immediately prior to the surgery. The incident
of SSI is reduced by using clippers because razors may cause breaks in
the skin and a possible pathway for microorganisms to enter the body.
(5) Postoperative Glucose Control
Diabetic patients may need to alter their normal regimen for diabe-
tes treatment when they have surgery. Hypoglycemia increases both
in-hospital mortality and the incidence of heart failure in patients