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Your Surgery Safety Briefing

Going to the hospital for surgery is a lot like taking a plane trip. The experience is potentially dangerous, but you trust the pilot—or the surgeon—to have the knowledge and expertise to keep you safe. Flight attendants—and healthcare workers in the hospital—will deal with any problems that develop. However, on a plane or in the hospital, you'll need to ring for help and may have to wait until other people's needs are addressed first.

There is one major difference: Before the plane takes off, flight attendants always provide a thorough safety briefing. Every passenger—from small children to adults of all ages and sizes—is taught how to buckle the seatbelts, check for exit locations, and follow emergency floor-path lights leading to each exit. In addition, you're shown how to remove a safety vest from under your seat, put it on correctly, and use the devices that inflate it. Finally, an attendant shows you how to put on an oxygen mask, start the airflow, and then assist a small child or elderly person who needs help doing so. Only then will the plane take off, leaving you at least somewhat prepared to manage emergency situations on your own.

Can you imagine a hospital safety briefing that teaches you how to operate an oxygen mask, or how to help yourself, or assist a friend or loved one, with any aspect of surgical care? Not likely. Hospitals believe you can rely on doctors and nurses to monitor your condition after surgery, and trust them to recognize and manage any signs of trouble.

Are you OK with that? I'm not! This book is designed to make you an empowered, active participant in your care and recovery. How does this apply to surgery? I think every surgery patient deserves a safety briefing, just as much as any airplane passenger. You'll find one here. You'll also find:

And that's not all. You probably know that airplane pilots use checklists to make sure they've completed each step needed for a safe takeoff and landing. I think every surgery patient also deserves a checklist. That's coming up, too. So fasten your seatbelt and get ready to take off for the hospital.

YOUR SURGERY SAFETY BRIEFING

“Hospitals are not the safe places we would like them to be.” That's the finding issued by members of the Surgical Patient Safety System Collaborative Group in a 2010 medical journal report.1 The group based their warning on a survey of almost 75,000 patient records from the United States, Canada, the United Kingdom, Australia, and New Zealand. They discovered that nearly 1 out of every 10 people admitted to the hospital experienced an “in-hospital adverse event” (harm resulting from medical care), which resulted in a longer hospital stay or a disability. Fortunately, most of the affected patients experienced only minor disabilities. Unfortunately, 7 percent of the patients died.2

Surgery-related problems—especially infections in the part of the body where the surgery took place (surgical site infections or SSIs)—accounted for more than half of all adverse events in this large group of patients.2 Compared with other surgery patients, people who developed surgical site infections were twice as likely to die, twice as likely to spend time in the intensive care unit, and five times more likely to need another hospitalization after being discharged from the hospital. If you develop a surgical site infection, you're also likely to need four, six, or even more extra days in the hospital, which adds significantly to the cost of care.3 That's the bad news.

Now for the good news. We know that 40–60 percent of surgical site infections can be prevented by simple practices. Patients like you can play an important role in ensuring that these practices are performed. The Centers for Disease Control and Prevention and other national organizations have developed infection prevention guidelines for both you and your healthcare workers.

For example, analysis of the study's 75,000 patient records showed that over 40 percent of all surgical site infections could have been prevented if healthcare workers had followed basic infection control procedures.2 These “best practice guidelines” include the following4:

Prevent Surgical Infections!

If you develop a surgical site infection, you have a greater risk of needing intensive care and a longer stay in the hospital. You might even die.

The good news is that you can help to protect yourself from getting an infection. Reminding healthcare workers to wash or sanitize their hands is No. 1 on your infection protection checklist.

In a study at eight hospitals from around the world, surgical complications occurred in 18 percent of patients before operating room checklists were used, compared with only 12 percent after introduction of surgical safety checklists. Death rates dropped from about 4 out of every 100 patients to between 1 and 2 out of every 100 patients.5

That's the benefit of using checklists in the operating room. But the study of 75,000 surgery patients I mentioned previously showed that only 41 percent of all adverse events occurred in the operating room; 25 percent occurred in patients' rooms.2 That's why many hospitals insist that healthcare workers follow lists of safety procedures (referred to as “bundles”) targeted to each stage of your care6:

Of course, just telling people what they should do doesn't guarantee they'll always do it. Typically, healthcare workers do only some checklist items while other items get neglected. You've already learned that many medical professionals forget to wash or sanitize their hands, even in the intensive care unit. It may be up to you to remind them, especially after surgery. That's why you can't just “sit back, relax, and enjoy the flight,” as you do on a plane.7

Infections can start at any stage of your surgical care, but you can play an active role in preventing them. Yes, you really can help yourself. This chapter will show you how.

PRE-OP PREPARATION

The American College of Surgeons, the organization that certifies surgeons' professional competence, wanted to know how much time and effort people spend preparing for surgery, compared with other important life events. Here's what their 1,000-person survey showed:

Even more surprising, about one out of three Americans in the survey who had undergone surgery didn't even check their surgeon's credentials beforehand.8 Was the surgeon board certified? Did he or she have specific training in the specialty involved in the procedure, that the patient was having? These details, and several others, are important factors in choosing a qualified surgeon. An excellent resource that gives information on how to choose a hospital or doctor is Consumer Reports at http://www.consumerreports.org/health/doctors-hospitals/hospitals/choosing-a-hospital/best-doctor.htm

Questions to Ask

By reading this book, you've already become an empowered patient, so I know you'll spend more than an hour choosing a qualified surgeon and a good hospital, and determining how much of your cost is covered by insurance. However, if you need emergency surgery, there's no time to make advance plans. So while you're feeling well, take time to ask which major hospital in your area your doctor would recommend for emergency care and which local surgeons are highly qualified to perform procedures you may need. Share this information with someone who can speak for you if you get too sick or injured to speak for yourself.

Good News!

Starting in 2012, patients and consumers have additional data to study before choosing a doctor or hospital. Our government will now make available to employers, insurance companies, and consumer groups data from Medicare claims that tell how often a surgeon performs a procedure and how often problems such as preventable complications result. Prior to this, only data from patients not on Medicare were available for comparision, which was not a good representation of all patients and doctors given the large number of patients that are on Medicare.

Doctors will be identified, but not patients, making it easy for consumers to find this information before they are hospitalized. These data will also allow for reports on many specialists as well. The first consumer reports should be available at https://www.cms.gov/medicare-coverage-database/.

In nonemergency situations, your pre-op preparation should also include meeting with the surgeon before you check into the hospital. You'll want to ask the following8,9:

During your pre-op visit, the surgeon will also ask you questions about your general health, allergies, nutrition, and medications you're taking. That's because people with some medical conditions are more likely to develop surgical site infections and may need preventive care.

Q: How do I know whether I have a higher risk of getting a surgical site infection?

A: We know that the following personal factors can increase your risk of developing an infection after surgery10:

  • Diabetes
  • Cigarette smoking
  • Use of steroids
  • Being overweight
  • Advanced age
  • Poor nutrition
  • Cancer and immune system diseases
  • Paralysis or limited mobility
  • Prolonged hospital stay before surgery
  • Already having an infection

PRE-OP PREVENTION

Preventing infections begins before you have your surgery. One important prevention step is to take control of the conditions on the risk list. For example, if you have diabetes, be sure you're maintaining healthy blood sugar levels. If you smoke, have a poor diet, or weigh too much, do something about it before scheduling your surgery.

Your surgeon may also tell you to reduce bacteria levels on your skin by bathing with an antiseptic soap containing chlorhexidine before you go to the hospital.11 You can purchase this over the counter in the drug store under the brand names such as Betasept, Calgon Vesta, Chlorostat, Hibiclens, and others. However, don't shave near the area where you'll have a surgical incision. Shaving was a standard procedure for many years, but we now know that shaving can cause small nicks in the skin that let bacteria get into the body.12

Of course, you can't control everything by yourself. For example, some people are unknowingly colonized with methicillin-resistant Staphylococcus aureus (MRSA) bacteria in their nostrils, even though they haven't yet developed an infection. To prevent the spread of these dangerous bacteria, many hospitals require incoming patients to have nasal samples cultured for S. aureus. Some patients found to be infected may be treated with a nasal antibiotic ointment.13

Five Steps to Take Before Surgery

  1. If you have diabetes, maintain healthy blood sugar levels. Check your A1c level, make sure it is less than 7 percent. (Hemoglobin A1c is a measure of your average blood sugar level during the prior 2–3 months.)
  2. If you smoke, quit now!
  3. If you're overweight, improve your diet and get more exercise to help burn more calories.
  4. Do not shave the area where you'll have surgery.
  5. If you have been told you have a MRSA infection, inform your surgeon.

Q: Are some surgeries more likely than others to result in an infection?

A: Yes. We know that infection risks are higher when surgery is performed on sites that we call dirty—like the bowel or a ruptured appendix. When a surgical procedure lasts more than 2 hours or requires blood transfusions during the operation, the risk of developing an infection is also increased.14

IN THE OPERATING ROOM

Whether or not you develop an infection depends not just on your health condition and your prevention efforts, but mostly on what happens in the operating room and in your hospital room. You won't be awake during surgery, but beforehand, you can watch for infection risks or errors, and speak up if you have concerns.

For example, if a healthcare worker tries to shave you with a razor, ask why. As you just read, preoperative shaving isn't recommended anymore. If hair needs to be removed, it should be done immediately before surgery, using a hair clipper.15

Before your surgery starts, a healthcare worker should check your name and ask you to confirm where the surgery will be performed. Left arm or right arm? Left leg or right leg? Chest or abdomen? According to the best practice guidelines, that person should put a mark on the correct site or ask you to do it yourself. If this is not done, then ask to speak with either your doctor or a member of the surgical team.

This may seem foolish to you, but operating on the wrong patient or on the wrong body part (“site”) happens more often than you think. In a study of medical errors from 2002 to June of 2008, physicians reported 25 wrong-patient incidents and 107 wrong-site incidents.16 These errors are known as “never events,” because they're so serious and so easily prevented that they should never occur. Make sure they never happen to you by insisting that the presurgery practice guidelines are followed.

Q: Will I be given an antibiotic before my surgery?

A: Use of antibiotics reduces the risk of infections in many surgical procedures. If your doctor tells you that you will receive antibiotics, the important question to ask is how he or she will ensure that the antibiotic is administered within 60 minutes before the first incision is made.12 The reason for the 60-minute window is that having the most antibiotic in your system at the time the incision is made will ensure that you are protected from bacteria that might get into the wound. For some antibiotics, administration 30–60 minutes before surgery is more effective than administration during the final 30 minutes.17

We know that if an antibiotic is given after surgery or too long before surgery, it has no effect in preventing infection. It is like closing the barn door after the horse is out. This may seem like something you'd assume that every doctor would know. Unfortunately, despite the presence of evidence and guidelines, the fact is that 25–50 percent of the time, the antibiotic is administered at the wrong time, at the wrong dose, or not at all.18,19 So if your doctor told you that an antibiotic would be given, remember to ask about it right before your surgery.

Don't Count on Doctors to Remember Everything!

Research shows the time you receive an antibiotic before surgery is very important in preventing an infection. So before you're wheeled into the operating room, be sure to ask if, and when, you'll be given an antibiotic.

Q: Will my blood sugar level be monitored before and after surgery?

A: As I mentioned before, if you are diabetic, your risk of a surgical site infection is greater than that of a non-diabetic person. In addition to the stress of having surgery, you may be told to stop taking your usual diabetes medications before surgery and to alter your normal meal schedule, all of which can cause an increase in blood glucose (sugar). Research has shown that non-diabetics also may have an upswing in blood glucose during and after surgery. According to a recent study, this excessively elevated blood sugar (hyperglycemia) may be the No. 1 risk factor for surgical site infections.20 (Note that “hyper” means high or above; “hypo” means low or below.) Make sure your hemoglobin A1c level is lower than 7 percent.

Whether or not you have diabetes, the message here is to make sure your blood glucose is checked before and after most types of major surgery, so appropriate medication can be given if necessary. Blood sugar monitoring should continue for 48 hours post-surgery, because high blood glucose levels continue to increase your risk of developing an infection.

How high is too high? Until recently, surgeons aimed to keep patients' blood sugar levels below 200 mg/dL, the American Diabetes Association's recommended level.21 However, recent studies show that more intensive glucose control—to levels below 140 mg/dL—may be needed to prevent infections.20,21 Ask your surgeon what's best for your type of surgery and your personal health history.

Q: I've heard that it's important to be kept warm during and after surgery. Is that true?

A: People get cold during surgery for two main reasons: operating rooms are kept at cool temperatures and surgical anesthesia interferes with the body's temperature-regulating mechanisms.22 Studies have shown that experiencing hypothermia (body temperature less than 96.8°F) during surgery can increase the risk of a surgical site infection and that patients who are kept warm to maintain normal temperature have lower rates of infection (especially during colon and rectal surgery).23 We also know that for any type of surgery, the occurrence of serious heart problems can be reduced by maintaining a normal body temperature.

On the basis of these reports, many physicians and medical organizations recommend monitoring patients' body temperatures during surgery, and “warming” anyone whose temperature falls below 96.8°F (this is purposely lower than 98.6°F, the usual “normal”). For example, hospitals throughout the United States participate in the Surgical Care Improvement Project (SCIP), a national quality partnership dedicated to reducing the rate of surgical complications. SCIP recommends warming for colorectal surgery patients.

However, a recent analysis of patient records for 398 SCIP member hospitals failed to show that maintaining normal body temperature during surgery decreased post-operative infections in these patients.24 A separate study at one SCIP member hospital also found no evidence that maintaining normal temperature during colorectal and other surgeries reduced the risk of surgical site infections.25 Current recommendations from the U.S. Centers for Disease Control do not include warming.12

Whether or not to control surgery patients' temperatures is still unresolved. Ask your surgeon if warming is used in your hospital. If so, it may be as simple as increasing the temperature in the operating room, having you wear a hat and booties during surgery, or putting a warmed blanket over you, especially before surgery, to help you store the heat in your body. Body temperature can also be maintained by administering warmed intravenous fluids during surgery.

Q: Are there any last-minute questions I should ask the surgeon?

A: Yes, there is one important question to ask, and it's sure to surprise you. Most hospitals have rules that limit the number of hours doctors can work during the 24-hour day, because fatigue and sleep deprivation seriously impair performance. In fact, one study showed that when surgeons got less than 6 hours of sleep before a non-emergency, daytime operation, their patients had a significant 83 percent increase in their risk of suffering complications.26

Some experienced surgeons might be able to do an excellent job even when they're half asleep, but would you want them to? I think surgeons should tell you if they're sleep deprived, so you can decide whether or not to go ahead with the scheduled operation. Their full disclosure is necessary for you to give truly informed consent to undergo a surgery. After all, you're about to be put to sleep, but you wouldn't want your surgeon to fall asleep, too.

POST-SURGERY INFECTION RISKS

Your operation is over, and everything went well. But it's still important to watch out for infections. Here's why. Our skin does an amazing job of protecting us from infections, but as you read in the previous chapters, even a small cut can let dangerous germs invade the body. Now just imagine how easy it is for germs to get through the much larger opening of your surgical incision. Although surgery is performed in an operating room under sterile conditions, using sterile instruments and supplies, you may think your surgical site couldn't become infected. Actually, there's no way to totally eliminate bacteria. You can get them from two sources27:

  1. Endogenous bacteria: These are the bacteria you already have on your skin. We think of them as part of the patient. Even if your skin is thoroughly cleaned with antibacterial agents, some endogenous bacteria will remain. When an incision is made, these bacteria can enter the body.

    You also have endogenous bacteria inside your body. For example, bacteria are always present inside the large intestines and other organs without causing any trouble. However, if they spill out during surgery, into spaces like the abdominal cavity (the peritoneum), serious infections can occur.

  2. Exogenous bacteria: These are bacteria from sources outside the patient. Sources can include air in the operating room, and contaminated surgical instruments and devices such as hip or knee replacements that are put in during surgery. Even the surgical silk sutures or metal staples used to close the incision can carry bacteria through your skin. Bacteria attach to the surfaces of these objects, then quickly multiply and produce toxins that help them survive and cause infection.

Q: I almost never get infections, even colds. So why is everyone warning me that I could get a surgical site infection?

A: After surgery, exogenous bacteria sources surround you, including environmental surfaces, medical equipment brought into your room, and people with infections who may be sharing the hospital room with you. Usually, your own immune system can fight these infections, but when you undergo surgery, your immune system is weakened. Bacteria take advantage of this opportunity to invade and cause infections.

Q: How will I know if I have a surgical site infection?

A: Surgical site infections occur in the area of the incision. It's normal to see some slight swelling or bruising around your closed incision right after surgery, but be on the alert for changes and other signs and symptoms of an infection, including

  • Redness at the site of the wound
  • Swelling
  • Heat (feeling warm to the touch)
  • Tenderness or pain
  • Drainage (bloody, pus-like fluid)
  • Odor

If you see anything suspicious, or if you develop a fever, tell your healthcare workers immediately. If you think the problem isn't being managed well, ask to speak directly with your doctor. Catching and treating an infection in the early stages can make a real difference in your recovery. Waiting could be disastrous.

Immediately after surgery is the time when being watchful and willing to ask questions can make a real difference in protecting yourself from developing a surgical site infection. The first 48 hours are especially important, because your wound (the closed incision) has not had time to start healing yet.23 You could be too weak or unable to help yourself at that point, so call on an advocate in advance to be with you after surgery.

Why You Need an Advocate

Immediately after surgery, you may be weak, tired, and not very alert.

That's why you need an advocate to stay with you at all times.

So be sure to make advance arrangements with a loved one or friend to be with you and speak for you as an advocate.

PREVENTION TIPS

As I've told you in almost every chapter of this book, the single most important thing you and your advocate can do to prevent infections is to make sure that you and all visitors and healthcare workers who come in contact with you washes their hands with soap and water or a sanitizer.

Bacteria and viruses can also spread via sneezing and coughing, so always cover your mouth when you sneeze or cough, and then wash or sanitize your hands. Ask people who come in contact with you to do the same.

When post-op surgical site infections occur, it's often the result of poor infection control practices and poor hand hygiene practices.28 Protect yourself! If you see something, say something! Remind healthcare workers and visitors to wash or sanitize their hands.

Wound Care

Hand hygiene reminders are particularly important when it comes to protecting your wound from germs. For example:

  • Your bandages should be changed and/or your wound area cleaned frequently. Be sure this is done using sterile practices. Seeing the healthcare worker open bandages or equipment wrappings marked “sterile” is a good sign.
  • Before any healthcare worker touches your wound area, be sure they wash or sanitize their hands first, and then use sterile procedures when putting on surgical gloves. If you don't actually see healthcare workers wash or sanitize, ask if they did.
  • During your hospital stay, don't touch your wound area and bandages, and don't let family or friends do so either. (Before you go back home, you may be told how to do this safely to help care for yourself.)

Daily Examinations

A doctor or other healthcare worker should examine you every day, to check for signs of infection or other problems.23 If it doesn't happen, say something! Ask about the schedule for daily examinations and then, if you notice the healthcare team is not adhering to that schedule, remind them of the routine they informed you about.

One more thing: If your hospital room is shared by other patients, ask them if they have any infections. If they do, this may suggest that an infection is going around, and you could be the next one to get it. Talk with your doctor and ask if you should be moved to a safer room.

IT'S TIME TO GO HOME!

Even if you're not moved to another hospital room, your next move could be out of the hospital. Due to cost cutting and insurance limitations, hospital stays are now much shorter than in the past. Patients are often discharged only 1 or 2 days after surgeries that used to require a week or more of recovery time in the hospital.

That means you'll be on your own—or with just a family member to help—to change your bandages, manage your pain medicines, and deal with any medical problem that arises, including a surgical site infection. These infections generally occur within 30 days after surgery, so you're likely to be back home if and when infection symptoms appear.29

In one study of 4,500 surgery patients, 89 people (about 2 percent) developed surgical site infections within 8 weeks after returning home. Compared with patients who stayed healthy, the infected patients needed significantly more outpatient doctor or emergency room visits, X-rays, home health aide services, and hospital readmissions, at an average total cost of over $5,000. In contrast, the other healthy patients cost “only” about $1,700 during that time period.29

Before You're Discharged

As the study showed, surgical site infections are not only uncomfortable, dangerous, and depressing, they're also time consuming and costly to treat. So I don't want you to be like the study's unfortunate 2 percent! Start protecting yourself by speaking with a discharge planner before you leave the hospital. Here's what you need to find out30:

Managing Home Care

In the hospital, healthcare workers checked your wound and changed your dressings. Now it's up to you to be vigilant in checking your wound every day. The most important thing to remember is to always wash or sanitize your hands before and after touching the bandages and the surgical site!

I don't expect you to remember every one of the many infection prevention tips you read about in this chapter, so I made a checklist for you on page 133. Pay special attention to the instructions about protecting your wound from germs.

Despite your good care, the wound area may develop swelling, redness, oozing, or other signs of infection. Call your doctor immediately if you suspect a problem.

  • Do not settle for speaking with a member of the office staff. Ask to speak with the doctor. If the doctor is not immediately available, ask to speak to a nurse (instead of an office staff person) and explain that you do need to speak with the doctor that day.
  • Provide a telephone number where you can be reached at any time, either at home or via a cell phone.

This can be a very difficult situation, because doctors' office staff members often act as gatekeepers and try to save doctors from being interrupted by unimportant phone calls. As a result, patients may be shy about demanding to speak with a doctor. I assure you that using the technique above will convey a sense of urgency, so your message will be quickly passed along to your doctor.

If you don't get a return call within a few hours, be sure to call again before office hours end that day. If you have signs of an infection, you cannot afford to wait until your scheduled post-operative visit. Be persistent!

DR. McGUCKIN, MEDICAL DETECTIVE

In previous chapters, you've read about some of the people I've met who developed serious, often preventable, healthcare acquired infections. The risk of these infections is especially high following surgery, and the damage is often tragic. When that happens, victims frequently sue the doctor or hospital. That's where I come in.

Here's what happened to a man I'll call Mr. X. At age 73, he needed surgery to remove a brain tumor of the left auditory nerve (the 8th vestibulocochlear nerve). It wasn't emergency surgery, and he had no previous or current medical conditions, so he was in the low-risk category for infection.

After surgery, Mr. X did well at first, but a few days later he developed a fever. Because his surgery was in the head area, doctors decided to take a culture of his spinal fluid to check for infection. They were right. The spinal fluid contained many white blood cells, a definite sign of infection. Looking at the fluid under a microscope, they saw a dangerous kind of rod-shaped bacteria (gram negative rods).

Checking further, they took a sample of fluid draining from Mr. X's head wound. Culture tests of the fluid identified the bacteria as Klebsiella. This suggested that the infection had started in his head wound and then spread to his spinal fluid.

Unfortunately, the infection continued to spread, causing meningitis, an infection of the membranes covering the brain and spinal cord. As a result, Mr. X developed weakness both arms and both legs (quadriparesis). How serious is this? It's related to quadriplegia, in which all four limbs are totally paralyzed.

When Mr. X filed a lawsuit, I was called in to investigate why and how he became infected. As usual, I started by reviewing hospital records for the 3 months around the time period Mr. X was hospitalized. I discovered that 12 other patients who were treated in the same intensive care unit as Mr. X also developed infections with the same Klebsiella bacteria. Clearly, there was an infection outbreak in that unit, and Mr. X was unlucky enough to wind up there.

Based on experience, I didn't need to dig too deeply to figure out how the infection had spread. As often happens, bacteria from the first infected patient or patients came in contact with equipment and surfaces in the intensive care unit. Most probably, new patients got infected through cross contamination—that is, transfer of bacteria from one person or object to another person. That happens when people don't wash or sanitize their hands! My conclusion: Infection prevention guidelines were not followed. Healthcare workers were not using basic hygiene practices and possibly were not properly sterilizing equipment in the intensive care unit. If the hospital hadn't been checking for infections, the only way to know was when Mr. X and other patients got sick. No wonder his case landed in court!

Q: Could Mr. X have done anything to prevent this terrible outcome?

A: The single most important thing he—or any patient, including you—could do is ask the surgeon if there were any outbreaks of infection or an unusual number of cues that infections were occurring in the hospital unit where he would be moved to after his surgery.

Q: What obligation did his surgeon have to tell him about this?

A: Remember what you read about informed consent? In order to give consent, a patient must be fully informed about all relevant facts. Mr. X's surgeon should have told him about the infection cluster. If the doctor didn't know about it, the hospital should have known and should have informed all their doctors.

Surgical Site Infection Prevention Checklist

When you go the hospital for surgery, you want to go home feeling better than when you came in. Avoiding surgical site infections can help to make that happen. Here are my “Top 10” steps you and your healthcare workers should take to prevent those infections:

  1. Take a shower or bath the night before, and the morning of, your surgery using a chlorhexidine cleanser, available at your local pharmacy.
  2. Ask about pre-operative antibiotics and be sure they are administered within one hour before the first surgical incision is made.
  3. Make sure your surgical site will not be shaved.
  4. Ask to have your blood sugar tested before surgery. If the surgery is elective, discuss your current hemoglobin A1c level with your doctor.
  5. Ask that your body temperature be monitored and controlled during and after surgery.
  6. If you were given antibiotic medication during surgery and are still receiving it after 24 hours, ask why it has not been discontinued.
  7. Make sure that you and every visitor and healthcare worker who comes in contact with you washes or sanitizes their hands before approaching your bed.
  8. Know the signs and symptoms of surgical site infection.
  9. Monitor your wound and any intravenous catheters daily for signs of infection.
  10. Contact your doctor if you have any concerns.