What patient education is recommended for an adult patient with comorbidities, such as diabetes, to prevent and manage surgical site infections?

Patient Education on Surgical Site Infection Prevention and Management

Patients with comorbidities like diabetes should be educated that their own skin and body bacteria are the primary source of surgical site infections, and that following specific preoperative and postoperative measures can reduce their infection risk by up to 50%. 1, 2

Understanding Your Infection Risk

Where Infections Come From

• Your own bacteria cause most infections: In clean surgical procedures, Staphylococcus aureus from your skin is the most common culprit, while in procedures involving the abdomen or pelvis, bacteria from your intestinal tract are responsible. 2, 1
• Hospital bacteria become relevant after 5-7 days: If you've been hospitalized recently (within 3 months) or stayed in intensive care, nursing homes, or rehabilitation centers, you may carry more resistant bacteria. 1
• Diabetes increases your risk: Your condition puts you at higher risk for infection, but you'll still get infections from the same bacteria that standard antibiotic prophylaxis covers—no special antibiotics are needed just because you have diabetes. 1

What You Must Do Before Surgery

Bathing and Skin Preparation

• Shower or bathe before surgery: This simple measure is strongly recommended by the WHO to reduce bacteria on your skin. 1
• Do not shave the surgical site yourself: Razors cause microscopic cuts that increase infection risk from 4.4% to 2.5%; if hair removal is necessary, clippers will be used instead. 3
• Expect chlorhexidine-alcohol skin preparation: Your surgical team will use this solution (rather than povidone-iodine) because it reduces infection rates from 6.5% to 4.0%. 3

Antibiotic Prophylaxis You'll Receive

• You'll get antibiotics within 30 minutes before incision: This timing is critical—the antibiotic must be in your bloodstream before bacteria can contaminate the surgical site. 1
• Antibiotics stop within 24 hours after surgery: The WHO and CDC strongly recommend discontinuing prophylactic antibiotics within 24 hours because continuing them longer provides no additional benefit and increases your risk of antibiotic resistance and C. difficile infection. 1, 4, 5
• The presence of surgical drains does NOT justify extended antibiotics: Even if you have drains, prophylactic antibiotics should still stop at 24 hours. 4

What Happens During Surgery (What Your Team Does)

Temperature Management

• You'll be kept warm: Active warming with heated blankets and warm IV fluids maintains your body temperature above 36°C (96.8°F), which reduces infection risk from 13% to 4.7%. 3

Blood Sugar Control (Critical for Diabetics)

• Your glucose will be monitored closely: Keeping your blood sugar below 150 mg/dL during and after surgery reduces infection risk from 16% to 9.4%—this is especially important for you as a diabetic patient. 3

Antibiotic Re-dosing During Long Procedures

• Additional antibiotic doses may be given: If your surgery lasts longer than 4 hours (for cefazolin) or 2 hours (for other antibiotics), or if you lose significant blood, you'll receive additional doses during the procedure. 1

After Surgery: What to Watch For

Daily Wound Inspection

• Examine your surgical wound daily: Look for increasing redness, warmth, swelling, pus, or separation of the wound edges. 1
• Fever alone in the first 72 hours is usually not infection: New fever within 3 days after surgery is common and doesn't automatically mean infection, but fever persisting beyond 72 hours should raise concern. 1

When Infection Develops

• Opening the wound is the primary treatment: If you develop an incisional infection, the most important treatment is opening the surgical incision widely to drain it—antibiotics alone are insufficient. 1
• Antibiotics may not be needed for simple wound infections: Studies show that for superficial abscesses, drainage alone without antibiotics is often effective; your surgeon will decide if antibiotics are necessary based on the extent of infection. 1

Common Pitfalls to Avoid

Antibiotic Misunderstandings

• Do not expect antibiotics after 24 hours "just in case": This practice is explicitly discouraged by global guidelines and increases your risk of resistant infections and complications. 1, 4
• Prophylactic antibiotics are different from treatment antibiotics: If you develop a true infection days after surgery, you'll need therapeutic (treatment) antibiotics, which are different drugs given for longer duration—but this is only if actual infection develops, not as prevention. 4

Risk Factor Clarifications

• Your diabetes doesn't require different prophylactic antibiotics: Despite being high-risk, you'll receive the same standard prophylactic antibiotics because they cover the bacteria you're likely to encounter. 1
• Recent hospitalization may require screening: If you've been hospitalized in the past 3 months, especially in intensive care, you may be screened for resistant bacteria like MRSA, which could change your antibiotic choice. 1

Signs Requiring Immediate Medical Attention

• Increasing wound redness, warmth, or swelling after the first few days 1
• Pus or foul-smelling drainage from the incision 1
• Wound edges separating or opening 1
• Fever persisting beyond 72 hours after surgery 1
• Severe pain at the surgical site that worsens rather than improves 1