Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017 | Critical Care Medicine | JAMA Surgery | JAMA Network
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Special Communication
August 2017

Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017

Author Affiliations
  • 1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
  • 2Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia
  • 3College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City
  • 4Carolinas Healthcare System, Charlotte, North Carolina
  • 5Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 6Section of Acute and Critical Care Surgery, Washington University School of Medicine in St Louis, Saint Louis, Missouri
  • 7American College of Surgeons Representative, University of Washington Medical Center, Seattle
  • 8Surgical Infection Society Representative, Veterans Affairs Boston Healthcare System, Boston University and Harvard Medical School, Boston, Massachusetts
  • 9Musculoskeletal Infection Society Representative, Mayo Clinic College of Medicine, Rochester, Minnesota
  • 10American Academy of Orthopaedic Surgeons Representative, Rush University Medical Center, Chicago, Illinois
  • 11American Academy of Orthopaedic Surgeons Representative, Rothman Institute, Philadelphia, Pennsylvania
  • 12Quality Department, Littleton Adventist Hospital, Denver, Colorado
  • 13Association of Perioperative Registered Nurses Representative, New York Methodist Hospital, Brooklyn
  • 14Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
  • 15Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
  • 16Department of Surgery, San Francisco General Hospital, University of California, San Francisco
JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904
Abstract

Importance  The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies.

Objective  To provide new and updated evidence-based recommendations for the prevention of SSI.

Evidence Review  A targeted systematic review of the literature was conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library from 1998 through April 2014. A modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and the strength of the resulting recommendation and to provide explicit links between them. Of 5759 titles and abstracts screened, 896 underwent full-text review by 2 independent reviewers. After exclusions, 170 studies were extracted into evidence tables, appraised, and synthesized.

Findings  Before surgery, patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the operative day. Antimicrobial prophylaxis should be administered only when indicated based on published clinical practice guidelines and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made. In cesarean section procedures, antimicrobial prophylaxis should be administered before skin incision. Skin preparation in the operating room should be performed using an alcohol-based agent unless contraindicated. For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses should not be administered after the surgical incision is closed in the operating room, even in the presence of a drain. Topical antimicrobial agents should not be applied to the surgical incision. During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL, and normothermia should be maintained in all patients. Increased fraction of inspired oxygen should be administered during surgery and after extubation in the immediate postoperative period for patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation. Transfusion of blood products should not be withheld from surgical patients as a means to prevent SSI.

Conclusions and Relevance  This guideline is intended to provide new and updated evidence-based recommendations for the prevention of SSI and should be incorporated into comprehensive surgical quality improvement programs to improve patient safety.

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