What measure reduces the risk of surgical site infection after a sigmoidectomy performed with previously used surgical instruments?

Maintaining Normothermia is the Key Measure to Reduce SSI Risk After Sigmoidectomy

The most effective measure to reduce surgical site infection risk after sigmoidectomy performed with previously used (but properly sterilized) instruments is maintaining perioperative normothermia (Option B). The question's premise about "previously used surgical instruments" is a red herring—proper sterilization is a baseline standard of care that should already be in place, not a measure implemented "now" after surgery has occurred 1.

Why Normothermia is the Correct Answer

Maintaining normothermia during the perioperative period is strongly supported by high-quality evidence as an effective SSI prevention strategy 1, 2. This intervention:

• Reduces SSI rates significantly: Active warming to maintain body temperature >36°C reduces SSI from 13% to 4.7% 2
• Is implemented during and immediately after surgery: This timing aligns with "now" in the clinical scenario 1
• Works through multiple mechanisms: Normothermia optimizes tissue oxygenation, maintains immune function, and promotes wound healing 1

Why Other Options Are Incorrect

Option A: Postoperative Antibiotics

Postoperative antibiotics are NOT recommended for SSI prevention 3, 4. The evidence is clear:

• Prophylactic antibiotics should be given preoperatively (within 60 minutes before incision), not postoperatively 1, 5, 6
• Single-dose preoperative prophylaxis is sufficient for most surgical procedures 5, 6
• Postoperative antibiotics are only indicated when infection has already developed with systemic signs 3, 4
• Extending antibiotics beyond the perioperative period increases resistance without reducing SSI 5

Option C: Sterilization in the Upcoming Surgery

This option is illogical because:

• Sterilization of surgical equipment is a mandatory baseline standard, not a special measure 1
• The question asks about measures "now" (after the current surgery), not future surgeries
• Proper sterilization should have already occurred before the sigmoidectomy 1

Option D: No Effect on the Wound

This is incorrect because multiple evidence-based interventions can reduce SSI risk even after surgery has been performed 1, 2.

The Complete SSI Prevention Bundle

While normothermia is the answer to this specific question, comprehensive SSI prevention includes 1, 2:

Preoperative measures:

• Intranasal mupirocin for staphylococcal decolonization 1
• Chlorhexidine-alcohol skin preparation (superior to povidone-iodine) 1, 2
• Hair clipping (not shaving) close to surgery time 1, 2
• Weight-based cephalosporin <60 minutes before incision 1

Intraoperative measures:

• Maintenance of normothermia (>36°C) 1, 2
• Glycemic control (glucose <150 mg/dL) 1, 2
• Redosing antibiotics for procedures >4 hours 1

Postoperative measures:

• Sterile dressing removal within 48 hours 1
• Continued normothermia during recovery 1

Common Pitfalls to Avoid

• Do not extend prophylactic antibiotics postoperatively without evidence of infection—this increases resistance without benefit 5, 6
• Do not assume instrument sterilization is optional or a "special measure"—it is mandatory standard of care 1
• Do not allow hypothermia during surgery—even mild hypothermia significantly increases SSI risk 1, 2
• Do not confuse SSI prevention (preoperative/intraoperative) with SSI treatment (postoperative antibiotics only for established infection) 3, 4