“Many surgical site infections are preventable,” said Michael S. Calderwood, MD, MPH, lead author of the updated guidelines and Chief Quality Officer at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire. “Ensuring that health care workers know about, use, and educate others about evidence-based prevention practices is critical to ensuring patient safety during and after surgery.”
Patients with surgical site infections are up to 11 times more likely to die than patients without such infections.
Treatment of Surgical Site Infections: Recommendations
- Obtain a complete allergy history from patients who self-report penicillin allergy. Many patients with self-reported penicillin allergy can safely take cefazolin, a cousin of penicillin, rather than alternative antibiotics that are less effective against surgical infections.
- For high-risk procedures, especially orthopedic and cardiothoracic surgery, preoperatively decolonize patients with an anti-staphylococcal agent. In this guideline, elevated decolonization to basic practice may reduce postoperative S. aureus infections.
- For patients with elevated blood glucose levels, monitor and maintain postoperative blood glucose levels between 110 and 150 mg/dL regardless of diabetes status. High glucose levels in the postoperative period are associated with higher infection rates. However, more intensive postoperative blood glucose control, targeting levels below 110 mg/dL, has been associated with significantly lower blood glucose levels and an increased risk of stroke or death.
- Use antimicrobial prophylaxis before elective colorectal surgery. Mechanical bowel preparation without the use of oral antimicrobial agents has been associated with significantly higher rates of surgical site infection and anastomotic leakage. The use of parenteral and oral antibiotics before elective colorectal surgery is now considered essential practice.
- Consider negative pressure dressings, especially for abdominal surgery or joint arthroplasty patients. Placing negative pressure dressings over closed incisions has been identified as a new option because evidence shows that these dressings reduce surgical site infections in some patients. Negative pressure dressings are thought to work by reducing fluid accumulation around the wound.
Additional topics covered in the update include specific risk factors for surgical site infections, control methods, infrastructure requirements, use of antiseptic wound irrigation and sterile recycling in the operating room, and other guidelines.
Once hospitals have fully implemented a list of core practices, they can consider these additional approaches to further improve outcomes. The paper classifies tissue oxygenation, antimicrobial powder, and gentamicin-collagen sponges as unsolved problems based on available evidence.
The document updates the 2014 Strategies for the Prevention of Surgical Site Infections in Acute Care Hospitals. First published in 2008, the Compendium is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and the Joint Commission, with significant input from representatives of a number of organizations and societies. with content expertise. The Compendium is a multi-year, highly collaborative executive writing work by more than 100 experts from around the world.
Upcoming Compendium updates will include strategies for preventing catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus infections, and implementation strategies for preventing healthcare-associated infections. Strategies to prevent central line-associated bloodstream infections, ventilator- and non-ventilator-associated pneumonia and events, and C. difficile infections, as well as strategies to prevent healthcare-associated infections through hand hygiene, were recently updated.
Each Collective article contains infection prevention strategies, performance measures, and approaches for implementation. The summary recommendations are derived from a synthesis of systematic literature review, evidence assessment, practical and implementation-based considerations, and expert consensus.