Table 1.

Components of the perioperative bundle.

Preoperative	• Appropriate oral antibiotic selection • Appropriate oral antibiotic administration the night before surgery • Mechanical bowel preparation • Medical evaluation for elevated hemoglobin A1C • Skin cleansing with chlorhexidine the night before and the morning of surgerya • Surgeon notification of SSI risk using MSK SSI prediction tool
Intraoperative	• Antibiotic administration before initial incisionb • Appropriate method of hair removal (electronic clippers or no hair removal) • Maintenance of normothermia • Intraoperative antibiotic re-dosing • Separate surgical closing tray for open procedures
Postoperative	• Discontinuation of antibiotics at 24 h • Patient shower on postoperative day 2

^aPatients were given a 4-oz (118-mL) bottle of 4% chlorhexidine gluconate (Hibiclens) during preoperative teaching and instructed to use it during a shower the night before and the morning of surgery. Written instructions were as follows. “To use Hibiclens, open the bottle and pour some solution into your hand or a washcloth. Move away from the shower stream to avoid rinsing off the Hibiclens too soon. Rub it gently over your body from your neck to your waist and rinse. Don’t let the solution get into your eyes, ears, mouth, or genital area. Don’t use any other soap. Dry yourself off with a clean towel after your shower.”

^bPreoperative intravenous antibiotics included 2 gm cefotetan, re-dosed every 6 h intraoperatively. Patients with penicillin allergy received clindamycin and gentamicin.