The Centers for Disease Control and Prevention have framed new guidelines for preventing surgical site infections based on thorough review of literature published in between 1998 to 2014.

Before framing the guidelines, the observations made from these reviews were graded, assessed and evaluated. These guidelines help reduce the risk of surgical site infections and hence have to be included into surgical quality improvement for the safety of patients.

Depending on the quality of evidence that supports a particular method of care or precaution to avoid surgical site infection, the guidelines have been grouped .

Strongly recommended    [Category I guidelines with high to moderate quality of evidence supported by appropriate clinical trials]

 

• The patient has to be administered a preoperative antimicrobial agent at a scheduled time such that the possibility of infection is minimized at the surgical site.
• Before cesarean deliveries, an appropriate antimicrobial agent should be applied on the skin before the skin incision.
• Additional prophylactic antimicrobial agents should not be administered after the surgical incision is closed.
• Post-surgery, antimicrobial agents such as ointments, solutions or powders should not be applied at the site of incision.
• Perioperative glycemic levels: The blood glucose levels should be less than 200mg/DL and maintained so before and during the surgery for both diabetic and non-diabetic patients.
• Patient undergoing surgery should be suggested to take a shower or bath a night before surgery with soap (antimicrobial or nonantimicrobial) or an antiseptic.
• Alcohol based antiseptic should be used to prepare the skin before surgery unless it is contraindicated.

Weakly recommended    [Category II guidelines with evidence from the clinical trials that could not conclude the benefits or harm of the precaution involved]

 

• Autologous platelet rich plasma application
• Use of triclosan coated sutures
• Application of microbial sealant during skin preparation for surgery
• Usage of aqueous idophor solution in contaminated abdominal procedures

No recommendations     [Category of unresolved issues which have a low to very low quality of evidence ] 

 

• Re-dose of parenteral prophylactic antimicrobial agent during the surgery
• Soaking the prosthetic devices used for implantation in antimicrobial agents
• Applying antimicrobial dressing in the operating room to the primary closure after surgical incision
• Optimal range of hemoglobin required in patients with or without diabetes
• Mode of delivery, timing or duration of medication to optimize the blood glucose levels
• Administering increased fraction of inspired oxygen through a face mask for patients with normal pulmonary function
• Duration of shower or the number of antiseptic applications to be used or use of chlorhexidine gluconate washed clothes for the prevention of SSI

With these new guidelines set for the postoperative care, the quality of the patient care can be improved which ultimately help save many lives. These guidelines are not only going to help the healthcare professionals but also researchers and organisations to come up with better and improvised versions for a better healthcare delivery. Guidelines falling under the unresolved issues category can be focused and appropriate clinical trials can be designed to conclude their results.

References

1. Sandra I. Berríos-Torres, MD; Craig A. Umscheid, MD, MSCE et al., Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017 JAMA Surg.
2. Brian Zimmerman, CDC issues new prevention guidelines for surgical site infections: 5 things to know. Beker’s Infection control & clinical quality, 2017
3. Pamela A. Lipsett, MD, Surgical site infection prevention- What we know and what we do not know, JAMA Surg. 2017