Preoperative Patient Screening
Clinical Objective
Confirm that each patient is an appropriate candidate for elective surgery on the day of the procedure, and identify any patient-level factors that require a modified infection prevention approach before the case proceeds.
Why This Matters
Proceeding with elective surgery in a patient with active infection elsewhere, compromised skin integrity near the surgical site, or an unrecognised history of resistant organisms significantly elevates SSI risk. These are identifiable factors — but only if they are systematically looked for. A patient who passed screening at scheduling may present differently on the day of surgery. This protocol is the last checkpoint before incision becomes the point of no return.
Critical Control Points
Screening completed on the day of surgery — not only at scheduling
Any finding that prompts deferral is documented and communicated to the client
Risk tier from Case Risk Stratification is updated if new findings emerge
Suitability decision made by the surgeon — not delegated
Screening Assessment
Each domain below carries a specific action threshold. Assess all five before proceeding.
| Assessment Domain | Finding | Action |
|---|---|---|
| Dermatologic | Skin intact, no active lesions near surgical region | Proceed |
| Mild dermatitis distant from surgical site | Modify plan — elevate risk tier | |
| Active skin infection or lesion near surgical region | Defer surgery | |
| Active infection elsewhere | No signs of active infection at any site | Proceed |
| Active infection confirmed at any site | Defer — treat and reassess | |
| Wounds / lick dermatitis | No wounds or lick lesions near surgical region | Proceed |
| Lick dermatitis or wound near surgical region | Modify plan — elevate risk tier | |
| Resistant organism history | No prior MRSP or resistant infection | Proceed |
| Prior MRSP or resistant infection confirmed | Modify plan — assign High risk tier, adjust prophylaxis | |
| Suitability for elective surgery today | All domains clear, patient stable | Proceed |
| One or more findings requiring action | Defer or modify — surgeon decision required |
Day-of-Surgery Screening Checklist
Step-by-Step Protocol
- 1
Review the patient's history and any new clinical notes on the day of surgery.
- 2
Complete physical inspection: skin, coat, and the planned surgical region. Note any lesions, wounds, or dermatitis.
- 3
Confirm there is no active infection at any site — ears, mouth, urinary tract, chronic wound sites.
- 4
Review prior microbiology records for MRSP or resistant organism history. Adjust prophylaxis plan if applicable.
- 5
Apply action thresholds from the screening table: proceed, modify plan, or defer.
- 6
Surgeon confirms suitability. If proceeding, update risk tier if any new findings have emerged.
- 7
Document all screening findings and the final suitability decision in the surgical record.
Key Pitfalls
Relying solely on the scheduling assessment — patients can develop new findings between booking and surgery day.
Delegating the suitability decision to nursing or technician staff.
Proceeding with elective surgery when active infection is present elsewhere in the body.
Failing to update the risk tier when new screening findings emerge on the day of surgery.
A patient who should not have surgery today is not a scheduling problem — it is a patient safety decision. The surgeon who proceeds despite a screening finding owns what follows. The surgeon who defers protects the patient and the outcome.