Updated Guidelines for Preventing Surgical Site Infections: Insights for Healthcare Providers

Strategies to prevent surgical site infections in acute care hospitals: 2022 Update

Summary and purpose

The intent of this document is to highlight practical recommendations in a concise format designed to help acute care hospitals implement and prioritize their surgical site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and the Joint Commission, with important contributions from representatives of various organizations and societies with expertise in the content.

Comments

Antibiotics administered before and during surgery should be stopped immediately after closing the patient’s incision, according to updated recommendations to prevent surgical site infections. Experts found no evidence that continuing antibiotics after a patient’s incision has been closed, even if they have drains, prevents surgical site infections. Continuing antibiotics increases the patient’s risk of developing a C. difficile infection, which causes severe diarrhea and antimicrobial resistance.

Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update , published in the journal Infection Control and Healthcare Epidemiology , provides evidence-based strategies to prevent infections in all types of surgeries from leading experts at five medical organizations led by the Society for Healthcare Epidemiology of America .

“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 healthcare personnel know, use, and educate others about evidence-based prevention practices is essential to keeping patients safe during and after their surgeries.”

Surgical site infections are among the most common and costly healthcare-associated infections, occurring in approximately 1% to 3% of patients undergoing inpatient surgery. Patients with surgical site infections are up to 11 times more likely to die compared to patients without such infections.

Other recommendations:

Obtain a complete allergy history from patients who self-report allergy to penicillin. Many patients with self-reported penicillin allergy can safely receive cefazolin, a cousin of penicillin, instead of alternative antibiotics that are less effective against surgical infections.
For high-risk procedures, especially orthopedic and cardiothoracic surgeries, decolonize patients with an antistaphylococcal agent in the preoperative setting. Decolonization, which was elevated to an essential practice in this guideline, may reduce postoperative S. aureus infections.
For patients with elevated blood glucose, monitor and maintain postoperative blood glucose levels between 110 and 150 mg/dL, regardless of diabetes status. Higher glucose levels in the postoperative environment are associated with higher infection rates. However, more intensive postoperative blood glucose control aimed at levels below 110 mg/dl has been associated with a risk of significant reduction in blood glucose level 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 leak. The use of parenteral and oral antibiotics prior to elective colorectal surgery is now considered an essential practice.
Consider negative pressure dressings, especially for patients with abdominal surgery or joint arthroplasty. Placing negative pressure dressings over closed incisions was identified as a new option because evidence has shown that these dressings reduce surgical site infections in certain patients. Negative pressure bandages are thought to work by reducing fluid buildup around the wound.

Additional topics covered in the update include specific risk factors for surgical site infections, surveillance methods, infrastructure requirements, use of antiseptic wound washing, and sterile reprocessing in the operating room, among other guidance.

Hospitals may consider these additional approaches when seeking to further improve outcomes after having fully implemented the list of essential practices. The document classifies tissue oxygenation, antimicrobial powder, and gentamicin-collagen sponges as unresolved issues based on current evidence.

The document updates the 2014 Strategies to Prevent Surgical Site Infections in Acute Care Hospitals. The Compendium, first published in 2008, is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, with the Infectious Diseases Society of America, the Association of Professionals in Infection Control and Epidemiology, the American Hospital Association, and the Joint Commission, with significant contributions from representatives of several organizations and societies. with content experience. The Compendium is a highly collaborative, multi-year guideline writing effort of more than 100 experts from around the world.

Future updates to the Compendium will cover 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, pneumonia and ventilator- and non-ventilator-associated events, and C. difficile infections were recently updated, as well as strategies to prevent central line-associated infections. medical care through hand hygiene. Each Compendium article contains infection prevention strategies, performance measures, and approaches to implementation. The compendium’s recommendations are derived from a synthesis of systematic literature review, evidence evaluation, practical and implementation-based considerations, and expert consensus.

Essential practices

The recommendation to administer prophylaxis according to evidence-based standards and guidelines was modified to emphasize that antimicrobial prophylaxis should be discontinued at the time of surgical closure in the operating room.
The use of parenteral and oral antibiotics prior to elective colorectal surgery is now considered an essential practice. This recommendation was included in the 2014 document, but was a sub-bullet recommendation. This recommendation was elevated to its own recommendation for greater emphasis.
Reclassified decolonization of surgical patients with an antistaphylococcal agent for cardiothoracic and orthopedic procedures from an additional approach to an essential practice.
The use of vaginal preparation with antiseptic solution prior to delivery by cesarean section and hysterectomy was added as an essential practice.
Intraoperative antiseptic wound washing reclassified from an additional approach to an essential practice. However, this approach should only be used when the sterility of the antiseptic can be guaranteed and maintained.
Monitoring of blood glucose levels during the immediate postoperative period for all patients was modified (1) to emphasize the importance of this intervention regardless of a known diagnosis of diabetes mellitus, (2) to raise the level of evidence to " high" for all procedures and (3) to reduce the target glucose level from <180 mg/dL to 110–150 mg/dL.
Reclassified use of packages to promote compliance with best practices from Unresolved to Essential Practice. The discussion on the use of checklists and packets was combined for this recommendation.
Observation and review of operating room personnel and the operating room care environment and central sterile reprocessing were reclassified from an additional focus to an essential practice.

Additional approaches

The recommendation to perform an SSI risk assessment was reclassified from Essential Practice to Additional Focus.
The use of negative pressure bandages was added as an Additional Practice. To date, available evidence suggests that this strategy is likely to be effective in specific procedures (e.g., abdominal procedures) and/or specific patients (e.g., increased body mass index).
The use of antiseptic-impregnated sutures was reclassified from Not Recommended to Additional Approaches.

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Updated Guidelines for Preventing Surgical Site Infections: Insights for Healthcare Providers

Recent updates in surgical site infection prevention strategies offer evidence-based recommendations for healthcare providers to enhance patient safety and optimize surgical outcomes.