CDC updates guidelines on surgical site infection prevention
- The Centers for Disease Control and Prevention issued new guidelines for preventing surgical site infections, replacing SSI prevention guidelines that were released back in 1999.
- The guidelines, published Wednesday in JAMA Surgery, break recommendations into four categories based on the strength of the supporting evidence.
- Among the recommendations are advising patients to shower or bathe completely the night before the surgery, using an alcohol-based antiseptic to prep skin before surgery in most cases, not withholding blood transfusions as a way to prevent SSI and not administering antimicrobials to the surgical wound.
Under the new scheme, strong recommendations are categorized as IA/supported by high to moderate-quality evidence, IB/low-quality evidence or IC/required by state or federal regulation. Category II denotes weak recommendations supported by any evidence suggesting a trade-off between clinical benefits and harms.
The guidelines are based on a review of nearly 5,500 studies published between 1998 and 2014. Of those, 896 underwent full-text review and 170 of those were culled for evidence.
In an invited commentary, Johns Hopkins School of Medicine surgery professor Pamela Lipsett said the updated guidelines clarify what is known about preventing SSIs, so that surgeons can take steps to reduce them, and where more evidence is needed.
“How do these guidelines help us in practice?” Lipsett writes. “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.”
The CDC guidelines follow a set of 29 recommendations for SSI prevention issued last fall by the World Health Organization. Some of the recommendations are the same, such as showering before surgery and not applying disinfectants to incisions.
Surgical site infections are associated with more than 400,000 extra hospital days and an added $900 million in costs in the U.S. annually, according to WHO.
Public health experts and healthcare organizations have been grappling to reduce the number of hospital-acquired infections. After South Carolina hospitals implemented WHO’s Surgical Safety Checklist, postsurgical deaths dropped by 22%. The state is the first to use the checklist statewide.
- JAMA Surgery Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017
- JAMA Surgery Surgical Site Infection Prevention—What We Know and What We Do Not Know
- Becker's Infection Control & Clinical Quality CDC issues new prevention guidelines for surgical site infections: 5 things to know