CDC releases new, evidence-based guidelines to prevent surgical site infections
The updated, evidence-based guidelines for prevention of surgical site infections (SSIs) recently released by the CDC* aims to help minimize the occurrence of SSIs, while highlighting areas that require further research.
“These new and updated recommendations are not only useful for healthcare professionals but also can be used as a resource for professional societies or organizations to develop more detailed implementation guidance or to identify future research priorities,” said the authors from the Healthcare Infection Control Practices Advisory Committee of the CDC. [JAMA Surg 2017;10.1001/jamasurg.2017.0904]
According to the authors, the previously published guidelines, [Am J Infect Control 1999;27:97-132] while evidence informed, was largely based on expert opinion “in the era before evidence-based guideline methods”. In contrast, the present guidelines were updated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
The recommendations in the new guidelines are based on a systematic review of 170 studies published between 1998 and April 2014, and are categorized according to strength ranging from Category IA (strong recommendation supported by high-to-moderate quality evidence) and Category IB (strong recommendation supported by low-quality evidence) to no recommendation/unresolved issue.
The Category IA recommendations advocate administration of appropriate parenteral prophylactic antimicrobial agents prior to incision in all Caesarean sections, avoidance of additional prophylactic antimicrobial agent doses after closure of surgical incision in the operating room (in clean and clean-contaminated procedures) even if drain is present, maintenance of normothermia and glycaemic control during surgery (glucose target of <200 mg/dL in patients with or without diabetes), and unless contraindicated, utilization of an alcohol-based antiseptic agent for intraoperative skin preparation.
Patients with normal pulmonary function who are undergoing general endotracheal anaesthesia should be given higher fraction of inspired oxygen during surgery and after extubation in the immediate postsurgery period, with perioperative normothermia and adequate volume replacement maintained (Category IA).
The use of prophylactic antimicrobial agents should be limited to instances when indicated by clinical practice guidelines and administration timed to ensure bactericidal concentration in serum and tissues at incision, while application of topical antimicrobial agents to surgical incision in order to prevent SSI should be avoided. Blood product transfusion from surgical patients should not be withheld to prevent SSI. Patients scheduled for surgery should shower or bathe using soap or an antiseptic agent on the night prior to surgery (all Category IB).
“The article from the CDC ... is useful to every surgeon ... it tells us what we should do and what we do not know,” commented Professor Pamela Lipsett from The Johns Hopkins University School of Medicine, Baltimore, Maryland, US, in an editorial. [JAMA Surg 2017;doi:10.1001/jamasurg.2017.0901]
The authors drew attention to the large number of recommendations that were categorized as unresolved (n=25 of 42 recommendations), which highlighted the need for further research.
“Adequately powered, well-designed studies that assess the effect of specific interventions on the incidence of SSI are needed to address these evidence gaps,” they said.