The most basic of surgical precautions — proper barrier protection, sharps injury prevention and reduction of surgical site infections — are the best ways to protect your staff from harmful bacteria or infectious diseases. Here's a refresher on the practices that eliminate cross-contamination risks and safeguard surgical teams from the dangers that lurk beneath the patient's skin.

Back to basics
True, surgical staffers rarely contract infections caused by MRSA, C. difficile and vancomycin-resistant Enterococcus, likely because they have robust immune systems. And, yes, they remain safe from hepatitis C and HIV infections as long as they practice sharps safety. Yet despite these facts, cross-contamination is a constant worry in the OR. Pre-op screenings can't identify all patients harboring harmful bacteria or infectious diseases. Assume that all patients presenting for surgery put your staff and other patients at risk.

Use a bundle approach to combat surgical site infections: Clean and decolonize the surgical site before the incision is made and protect it from bacteria colonization following surgery.

Our patients are asked to shower the night before surgery and scrub surgical sites with chlorhexidine to build up the solution's antimicrobial effect, which is reinforced on the day of surgery with chlorhexidine gluconate pre-op skin preps. Antimicrobial gauze dressings are applied to incisions after surgery. This multi-modal approach attacks surgical site infections from all possible angles.

Additional precautions
While you should follow national standards of care for every patient, take additional precautions when patients harboring contagious bacteria or infectious diseases present for surgery. Make sure your anesthesia providers are gowned and gloved when working on contagious patients. They work around the patient's head, and are likely to come in contact with contaminated flora in the patient's nose or on his face, chest and hair. The providers then touch IVs, anesthesia equipment and medications, increasing cross-contamination risks in the OR.

Cover opened surgical supply carts in the OR with a clear plastic drape for added cross-contamination protection. OR orderlies and housekeepers are also potential carriers of harmful bacteria; ask them to don gowns and gloves when working around contagious patients. They handle equipment and supplies that may have come in contact with the patient, and may transport dangerous organisms to other areas of your facility. For that reason, orderlies should remove their gloves and sanitize their hands after leaving the OR and before entering supply storage areas.

Colonizing bacteria feed off sugar, putting a greater emphasis on controlling glucose levels for all patients in general and for contaminated patients in particular. One of the Joint Commission's proposed 2009 National Patient Safety Goals addresses this concern, stating you must "maintain optimal control of blood glucose levels (as defined by the organization) with standardized protocols during the peri-operative period for surgical procedures."

Pre-op screening should identify patients with high glucose levels, letting them work with their primary care physicians to control the problem before they reach your OR tables. But not all hyperglycemic patients will be identified before surgery. Manage hyperglycemic patients on the day of surgery with insulin drips in PACU to stabilize glucose levels and protect against the onset of SSIs.

Do your part
Surgical site infections are often traced back to a specific facility, and sometimes even to a particular surgical team. That can be unfair to staffers who follow correct infection control protocols and take every precaution imaginable, only to have infections develop in obese or diabetic patients who may not be aware that their dietary choices increase SSI risks. While patients must realize their role in avoiding SSIs and take responsibility for their care, the onus is on you to protect patients — and therefore your staff — from infectious bacteria and diseases.