The
Centers for Disease Control and Prevention (CDC) has issued updated
evidence-based recommendations for preventing surgical site infections
(SSIs). The guidelines cover 14 core areas and are intended for
incorporation into existing surgical quality improvement programs for
greater patient safety.
The 2017 recommendations, published online today in JAMA Surgery, supersede the CDC's 1999 SSI guidelines, which were published before the routine use of evidence-based grading.
After an initial systematic literature review of more than 5000 items published between 1998 and 2014, the CDC's Healthcare Infection Control Practices Advisory Committee settled on 170 eligible studies for analysis. Using a modified version of the standard GRADE approach (Grading of Recommendations, Assessment, Development, and Evaluation), the panel assessed evidence quality and balance of benefits and harms, assigned a strength level for each recommendation, ranging from 1A (strong recommendation with evidence of high to moderate quality) to no recommendation/unresolved issue. Of 42 statements, 25 ended up with no recommendation/unresolved status.
Among the updated recommendations:
Led by Sandra I. Berrios-Torres, MD, from the CDC's Division of Healthcare Quality Promotion in Atlanta, Georgia, the guideline authors stress that prevention of SSIs is ever more important as the number of US surgical procedures rises and reimbursements for SSIs are being reduced or denied.
Between 2006 and 2009, primary site infections complicated approximately 1.9% of surgeries in the United States, the authors note, and the true number is likely higher, as approximately half of SSIs manifest after discharge, the authors note.
The authors add that although the 1999 guideline was "evidence informed," most of its recommendations were based on expert opinion, as evidence-based guideline methods were not the norm the time. They anticipate the 2017 recommendations will serve both healthcare practitioners wanting more precise guidance on implementation and organizations seeking to set research priorities.
The 2017 recommendations, published online today in JAMA Surgery, supersede the CDC's 1999 SSI guidelines, which were published before the routine use of evidence-based grading.
After an initial systematic literature review of more than 5000 items published between 1998 and 2014, the CDC's Healthcare Infection Control Practices Advisory Committee settled on 170 eligible studies for analysis. Using a modified version of the standard GRADE approach (Grading of Recommendations, Assessment, Development, and Evaluation), the panel assessed evidence quality and balance of benefits and harms, assigned a strength level for each recommendation, ranging from 1A (strong recommendation with evidence of high to moderate quality) to no recommendation/unresolved issue. Of 42 statements, 25 ended up with no recommendation/unresolved status.
Among the updated recommendations:
- Advise patients to have a full-body shower or bath with soap (antimicrobial only as needed) or an antiseptic agent no earlier than the night before the day of surgery.
- Before cesarean delivery, administer antimicrobial prophylaxis before incision.
- In most cases, use an alcohol-based agent for skin preparation in the operating room.
- It is not necessary to use plastic adhesive drapes with or without antimicrobial properties to prevent SSIs.
- For clean and clean-contaminated procedures, do not give additional prophylactic antimicrobial doses after closing the surgical incision, even if the patient has a drain in place.
- Do not apply topical antimicrobial agents to the incision.
- Maintain intraoperative glycemic control in diabetic and nondiabetic patients, targeting blood glucose levels of less than 200 mg/dL.
- Maintain patient normothermia.
- In patients with normal lung function undergoing general anesthesia with endotracheal intubation, administer a higher fraction of inspired oxygen during surgery and after extubation in the immediate postoperative period.
- Do not withhold transfused blood products as a means to prevent SSI.
Led by Sandra I. Berrios-Torres, MD, from the CDC's Division of Healthcare Quality Promotion in Atlanta, Georgia, the guideline authors stress that prevention of SSIs is ever more important as the number of US surgical procedures rises and reimbursements for SSIs are being reduced or denied.
Between 2006 and 2009, primary site infections complicated approximately 1.9% of surgeries in the United States, the authors note, and the true number is likely higher, as approximately half of SSIs manifest after discharge, the authors note.
The authors add that although the 1999 guideline was "evidence informed," most of its recommendations were based on expert opinion, as evidence-based guideline methods were not the norm the time. They anticipate the 2017 recommendations will serve both healthcare practitioners wanting more precise guidance on implementation and organizations seeking to set research priorities.
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