Sandra I Berríos-Torres1, Craig A Umscheid2, Dale W Bratzler3, Brian Leas2, Erin C Stone1, Rachel R Kelz2, Caroline E Reinke4, Sherry Morgan2, Joseph S Solomkin5, John E Mazuski6, E Patchen Dellinger7, Kamal M F Itani8, Elie F Berbari9, John Segreti10, Javad Parvizi11, Joan Blanchard12, George Allen13, Jan A J W Kluytmans14,15, Rodney Donlan1, William P Schecter16. 1. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. 2. Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia. 3. College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City. 4. Carolinas Healthcare System, Charlotte, North Carolina. 5. Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio. 6. Section of Acute and Critical Care Surgery, Washington University School of Medicine in St Louis, Saint Louis, Missouri. 7. American College of Surgeons Representative, University of Washington Medical Center, Seattle. 8. Surgical Infection Society Representative, Veterans Affairs Boston Healthcare System, Boston University and Harvard Medical School, Boston, Massachusetts. 9. Musculoskeletal Infection Society Representative, Mayo Clinic College of Medicine, Rochester, Minnesota. 10. American Academy of Orthopaedic Surgeons Representative, Rush University Medical Center, Chicago, Illinois. 11. American Academy of Orthopaedic Surgeons Representative, Rothman Institute, Philadelphia, Pennsylvania. 12. Quality Department, Littleton Adventist Hospital, Denver, Colorado. 13. Association of Perioperative Registered Nurses Representative, New York Methodist Hospital, Brooklyn. 14. Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands. 15. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands. 16. Department of Surgery, San Francisco General Hospital, University of California, San Francisco.
Abstract
IMPORTANCE: The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies. OBJECTIVE: To provide new and updated evidence-based recommendations for the prevention of SSI. EVIDENCE REVIEW: A targeted systematic review of the literature was conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library from 1998 through April 2014. A modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and the strength of the resulting recommendation and to provide explicit links between them. Of 5759 titles and abstracts screened, 896 underwent full-text review by 2 independent reviewers. After exclusions, 170 studies were extracted into evidence tables, appraised, and synthesized. FINDINGS: Before surgery, patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the operative day. Antimicrobial prophylaxis should be administered only when indicated based on published clinical practice guidelines and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made. In cesarean section procedures, antimicrobial prophylaxis should be administered before skin incision. Skin preparation in the operating room should be performed using an alcohol-based agent unless contraindicated. For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses should not be administered after the surgical incision is closed in the operating room, even in the presence of a drain. Topical antimicrobial agents should not be applied to the surgical incision. During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL, and normothermia should be maintained in all patients. Increased fraction of inspired oxygen should be administered during surgery and after extubation in the immediate postoperative period for patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation. Transfusion of blood products should not be withheld from surgical patients as a means to prevent SSI. CONCLUSIONS AND RELEVANCE: This guideline is intended to provide new and updated evidence-based recommendations for the prevention of SSI and should be incorporated into comprehensive surgical quality improvement programs to improve patient safety.
IMPORTANCE: The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies. OBJECTIVE: To provide new and updated evidence-based recommendations for the prevention of SSI. EVIDENCE REVIEW: A targeted systematic review of the literature was conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library from 1998 through April 2014. A modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and the strength of the resulting recommendation and to provide explicit links between them. Of 5759 titles and abstracts screened, 896 underwent full-text review by 2 independent reviewers. After exclusions, 170 studies were extracted into evidence tables, appraised, and synthesized. FINDINGS: Before surgery, patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the operative day. Antimicrobial prophylaxis should be administered only when indicated based on published clinical practice guidelines and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made. In cesarean section procedures, antimicrobial prophylaxis should be administered before skin incision. Skin preparation in the operating room should be performed using an alcohol-based agent unless contraindicated. For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses should not be administered after the surgical incision is closed in the operating room, even in the presence of a drain. Topical antimicrobial agents should not be applied to the surgical incision. During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL, and normothermia should be maintained in all patients. Increased fraction of inspired oxygen should be administered during surgery and after extubation in the immediate postoperative period for patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation. Transfusion of blood products should not be withheld from surgical patients as a means to prevent SSI. CONCLUSIONS AND RELEVANCE: This guideline is intended to provide new and updated evidence-based recommendations for the prevention of SSI and should be incorporated into comprehensive surgical quality improvement programs to improve patient safety.
Authors: Roger V Ortines; Yu Wang; Haiyun Liu; Dustin A Dikeman; Bret L Pinsker; Robert J Miller; Sophia E Kim; Nicole E Ackerman; Joe F Rizkallah; LeeAnn T Marcello; Taylor S Cohen; Christine Tkaczyk; Bret R Sellman; Lloyd S Miller Journal: Antimicrob Agents Chemother Date: 2019-07-25 Impact factor: 5.191
Authors: Daniela Bertschi; Walter P Weber; Jasmin Zeindler; Daniel Stekhoven; Robert Mechera; Lilian Salm; Marco Kralijevic; Savas D Soysal; Marco von Strauss; Edin Mujagic; Walter R Marti Journal: World J Surg Date: 2019-10 Impact factor: 3.352