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Invited Commentary
May 3, 2017

Surgical Site Infection Prevention—What We Know and What We Do Not Know

JAMA Surg. Published online May 3, 2017. doi:10.1001/jamasurg.2017.0901

Surgical site infections remain among the most common preventable infections today. Recently, the World Health Organization1,2 and the American College of Surgeons and Surgical Infection Society3 published their guidelines for the prevention of surgical site infections. In this journal, the long-awaited update to the 1999 guidelines from the Centers for Disease Control and Prevention (CDC) have now been published.4,5 With the publication of guidelines from 3 reputable sources, where should the surgeon turn for guidance? What are the major controversies? What is new and where do we need to perform new research? The CDC guidelines use a strict process for literature review, development of consensus, public reporting, and refinement of their final recommendations. The article from the CDC by Berríos-Torres et al5 in this issue of JAMA Surgery is useful to every surgeon because it is brief and summarizes the recommendations, with their level of support. It tells us what we should do and what we do not know. The supplementary material is inclusive and recommended for anyone with a thirst for the evidence supporting these recommendations. Unfortunately, in many cases the authors make no recommendation with respect to support or harm if the level of the evidence was low or very low or if they were unable to judge trade-offs between harms and benefits of the proposed intervention because of lack of outcomes. The authors ultimately provide 42 statements, including 8 Category 1A, 4 Category 1B, 5 Category II, and 25 areas for which they made no recommendation or considered the area unresolved. The fact that most statements were unresolved, especially regarding prosthetic joint surgery, shows our investigators where we should be putting forth our efforts in clinical trials. There is a lot of opportunity to learn how we can provide more effective care to our patients.

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