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CDC Issues First SSI-prevention Update in 18 Years

New recommendations address pre-op bathing, prepping, patient warming, antimicrobials and more.

Published: May 4, 2017

PRECLEANING Patients should shower or bathe with antimicrobial or nonantimicrobial soap at least the night before surgery, says the CDC.

Citing increasing demand for evidence-based interventions to prevent surgical-site infections, the Centers for Disease Control has published updated SSI-prevention guidelines for the first time since 1999, when, it says, most of its recommendations were based on expert opinion rather than evidence.

The CDC boiled down thousands of "potentially relevant studies" into 170 high-quality trials to issue these recommendations:

  • Patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before surgery.
  • Antimicrobial prophylaxis should be administered only when indicated and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made.
  • Skin prep in the OR should be done with 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 OR, even when a drain is being used.
  • 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.
  • Normothermia should be maintained in all patients.
  • For patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation, increased fraction of inspired oxygen should be administered during surgery and immediately after extubation in post-op.
  • Blood transfusions should not be withheld from surgical patients as a means to prevent SSIs.

In an accompanying editorial, Pamela A. Lipsett, MD, MHPE, MCCM, a professor in the department of surgery, anesthesia and critical care medicine at the Johns Hopkins University School of Medicine in Baltimore, Md., says the CDC's long-awaited guidelines tell surgical teams what they should do and what is still unknown. She acknowledges that the recommendations are supported by evidence, but writes, "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 tradeoffs between harms and benefits of the proposed intervention because of lack of outcomes."

Dr. Lipsett says there is still opportunity to learn about providing more effective care to patients, and believes the new guidelines show the way forward.

Jim Burger


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