Even in common procedures like hip and knee replacements, surgical site infections (SSIs) – an infection occurring at the site of the surgery – can occur. Almost 300,000 SSIs occur annually in the United States. Estimates suggest that up to half may be preventable with the use of current evidence–based strategies. Additionally, due to antimicrobial–resistant pathogens, the costs and challenges associated with treating SSIs is growing.

A guideline published in JAMA Surgery journal by the Centers for Disease Control and Prevention, and supported by Craig A Umscheid, MD, MSCE, vice chair for Quality and Safety at Penn Medicine and an associate professor in General Internal Medicine, and his team, provides the most up to date recommendations for clinicians and organizations about how to prevent SSIs in their care settings.

The guideline is based on a systematic literature review of 170 studies conducted by Umscheid and his colleagues, and examines 10 core domains that pertain to all surgical procedures and 10 additional areas that pertain strictly to orthopaedic surgery. For example, one core recommendation suggests providing a higher percentage of inspired oxygen to reduce the risk of surgical site infections for patients who are intubated (i.e. have a tube inserted into their throat to help them breathe) during their procedure. Other core recommendations advise surgeons about how to administer intravenous antibiotics during a procedure, and to limit antibiotics after a procedure when there is no benefit and only harm.

The section on joint replacement makes recommendations about the use of blood transfusions, what to do for patients who are on steroids to minimize infection risk during a surgical procedure, and biofilms on prosthetic joints. If a patient gets a joint infection, one of the biggest problems is that the inserted hardware can also get infected, and an impenetrable biofilm can form around the infected hardware such that antibiotics cannot clear the infection, thus forcing surgeons to remove the prosthetic joint.

One of the core recommendations is about keeping patients warm during surgery. If the patient gets cold in the operating room, this can increase the risk of surgical site infection. So the surgical team should use blankets and devices like bear huggers to keep patients warm during the operating room procedure to reduce the risk.

In the study, the team discusses how best to administer intravenous antibiotics or prepare a surgical site before a surgeon makes an incision to prevent infection. You also provide recommendations about how to control blood sugar levels. Many health care organizations have implemented most or all of these practices, but we hope this work informs those who have room to improve – institutions that might have practice gaps between what we know works and what their practicing in the real world. Most importantly, we hope this guideline helps address the ongoing debates over some of the controversial issues in SSI prevention – such as how to prepare a surgical site, how long to give antibiotics after a procedure, how much oxygen to give patients during a procedure, whether to use triclosan coated sutures to prevent SSI, and so on.

This latest work is more than five years in the making, and early signals suggest it may have great impact.