The CDC published its long-awaited update on recommendations for the prevention of surgical site infections on Wednesday in JAMA Surgery.
The new guidelines supplant the agency’s previous SSI prevention guidelines issued in 1999, with the CDC’s Sandra Berríos-Torres, MD, serving as the lead author.
A review of more than 5,000 studies published from 1998 through 2014 was conducted by researchers. After undergoing a full-text review, researchers found that 170 studies were eligible and fully analyzed.
New recommendations include:
♦ Advising patients to complete a full-body shower 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.
♦ 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.
In an invited commentary discussing the guidelines also published in JAMA Surgery, Pamela Lipsett, MD, a professor for surgery at Johns Hopkins Medicine in Baltimore, wrote the new guidelines are useful to every surgeon because it distinguishes between what surgeons should to do to prevent SSIs and what remains unknown about SSI prevention.
“How do guidelines help us in practice? When their development is rigorous, experts are used to systematically review the evidence and tell us what we can do (or not do) for most patients,” wrote Dr. Lipset. “The guidelines by [Dr.] Berríos-Torres et al do exactly that, and they show us the way forward.”
You can find the full recommendations here.