Step 1. Prevent surgical site infections
-Monitor and maintain normal glycemia
-Maintain normothermia
-Perform proper skin preparation using appropriate antiseptic agent and, when necessary, hair removal techniques
-Think outside the wound to stop surgical site infections

Step 2. Prevent device-related infections: get the devices out
-Use catheters only when essential
-Use proper insertion and catheter-care protocols
-Use drains appropriately
-Remove catheters and drains when they are no longer essential

Step 3. Prevent hospital-acquired pneumonia
- Wean from the ventilator when appropriate
- Elevate head of bed to 30°
- Drain circuit/tubing condensate away from patient
- Prevent contamination of respiratory therapy equipment, ventilator circuits and respiratory medications.

Step 4. Target the pathogen
- Target empiric antimicrobial therapy to likely pathogens
- Obtain appropriate cultures
- Target definitive antimicrobial therapy to known pathogens
- Optimize timing, regimen, dose, route, and duration of antimicrobial therapy
- Practice safe source control (e.g. debridement, or open wound as indicated)

Step 5. Access the experts
- Consult the appropriate expert for complicated infections:
surgeons; infectious disease experts; clinical pharmacists

Step 6. Start prophylactic antimicrobials promptly
- Give the initial dose within one hour preceding incision
- Use the appropriate antimicrobial and dosing
- Repeat the dose during surgery as needed to maintain blood levels

Step 7. Stop prophylactic antimicrobials within 24 hours
- Discontinue use even with catheters or drains still in place

Step 8. Use local data
- Know your antibiogram
- Know your formulary
- Know your patient population

Step 9. Know when to say “no” to vanco
- Vanco should be used to treat known infections, not for routine prophylaxis
- Treat staphylococcal infection, not contaminants or colonization
- Consider other antimicrobials in treating MRSA

Step 10. Treat infection, not contamination or colonization
- Use proper antisepsis for drawing blood cultures
- Get at least one peripheral vein blood culture, if possible
- Avoid culturing vascular catheter tips
- Treat bacteremia, not the catheter tip

Step 11. Contain your contaminant and contagion
- Follow infection control precautions
- Consult infection control teams

12. Practice hand hygiene
- Set an example
- Wash your hands or use an alcohol-based handrub
- Do not operate with open sores on hands
- Do not operate with artificial nails
- Promote good habits for the entire surgical team