# A nurse is implementing an evidence-based surgical site infection (SSI) prevention bundle for a patient scheduled for elective colon resection. Which interventions are part of the bundle? Select all that apply.

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372764&lang=en  
> language: en  
> subject: Complications of Procedures  
> category: ROR

## Question

A nurse is implementing an evidence-based surgical site infection (SSI) prevention bundle for a patient scheduled for elective colon resection. Which interventions are part of the bundle? Select all that apply.

1

Use clippers, not razors, to remove hair at the surgical site, performed as close to the time of surgery as possible.

2

Withhold intraoperative blood glucose monitoring because tight glycemic control increases hypoglycemia risk and is no longer recommended.

3

Administer the prophylactic antibiotic so that infusion is complete within 60 minutes before surgical incision (120 minutes for vancomycin or fluoroquinolones).

4

Maintain perioperative blood glucose below 180 mg/dL in diabetic and non-diabetic patients during the immediate postoperative period.

5

Maintain perioperative normothermia, with temperature kept above 36 °C using forced-air warming and warmed IV fluids.

## Explanation

The CMS/SCIP and current Joint Commission evidence-based SSI prevention bundle includes: (1) prophylactic antibiotic timing — infusion complete within 60 minutes before incision, 120 minutes for vancomycin or fluoroquinolones because of longer infusion times; (2) clippers (not razors) close to surgery to avoid skin nicks that increase SSI risk; (3) perioperative normothermia (>36 °C) with forced-air warming and warmed fluids — hypothermia impairs neutrophil function and oxygen delivery; (5) perioperative glucose <180 mg/dL — hyperglycemia impairs immune function regardless of diabetes status. Choice 2 is incorrect — glucose monitoring is part of the bundle, not withheld; the recommendation moved away from very tight (<110) control to a target under 180 because aggressive control caused hypoglycemia, but monitoring is essential.

## In-depth explanation

The evidence-based surgical site infection prevention bundle (CMS/SCIP and Joint Commission) bundles a small set of perioperative interventions that, applied together, substantially reduce SSI. The core elements are timely prophylactic antibiotics with infusion complete within 60 minutes before incision (120 minutes for vancomycin or fluoroquinolones), hair removal with clippers (not razors) close to the time of surgery, perioperative normothermia kept above 36 degrees Celsius with forced-air warming and warmed IV fluids, perioperative glucose control below 180 mg/dL in both diabetic and non-diabetic patients, appropriate skin antisepsis (chlorhexidine-alcohol where appropriate), and discontinuation of antibiotics within 24 hours after surgery. The bundle does not advocate withholding glucose monitoring; the historical pendulum from very tight intraoperative glucose control swung to a more moderate <180 target, but monitoring remains central. Adherence to the bundle as a unit, rather than to individual elements, is what produces measurable SSI reduction.

## Clinical scenario

A nurse is implementing an **evidence-based surgical site infection (SSI) prevention bundle** for a patient scheduled for **elective colon resection**.

## Key concepts

- **SSI Prevention Bundle Elements** — Prophylactic antibiotic timed to be complete within 60 minutes before incision (120 min for vancomycin/fluoroquinolones), clippers not razors close to surgery, normothermia >36 °C, glucose <180 mg/dL in all patients, appropriate skin antisepsis (chlorhexidine-alcohol), antibiotic discontinuation within 24 hours postoperatively.
- **Why Clippers, Not Razors** — Razors create microscopic skin nicks that become bacterial entry points and significantly increase SSI risk. Clippers cut hair at the surface without breaking skin. Hair removal is performed close to the time of incision because earlier removal allows colonization to redevelop.
- **Perioperative Normothermia** — Body temperature >36 °C reduces SSI by preserving neutrophil function, tissue oxygen delivery, and platelet function. Forced-air warming blankets and warmed IV fluids are standard. Hypothermia is associated with two- to threefold increase in SSI in colorectal surgery.

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