Updated Guidelines Released for Preventing Surgical Site Infections

Surgeons should counsel patients to completely refrain from smoking for a minimum of four to six weeks before elective surgery.

Short-term blood glucose control before, during, and after surgery is more important than long-term blood sugar maintenance. There now is high-quality evidence to support expanding blood sugar control to all patients, regardless of diabetic status.

Studies of individual procedures have shown promising results when using topical and local antibiotics to reduce infections.

Hair in the surgical site should be removed only if it would interfere with surgery, as shaving causes microscopic cuts and abrasions, resulting in disruption of the skin's barrier defense against microorganisms. Clippers generally should be used instead of razors to remove hair.

Historically, guidelines have not recommended using antibiotic sutures to decrease SSIs, but there now is considerable evidence to support their use.

Double gloving decreases the risk of holes to the inner glove, so routine double gloving is recommended to protect the surgeon.

Early showering does not increase the risk of SSIs and can be encouraged at the surgeon's discretion.

“SSIs are the most common and costly of all hospital-acquired infections, accounting for 20% of all hospital-acquired infections. They occur in an estimated 2-5% of patients undergoing inpatient surgery,” concluded lead author Kristen Ban, MD, of ACS and Loyola University Medical Center, and colleagues. “Guidelines serve as a starting point for the delivery of evidence-based care, but they are only useful if they are implemented successfully. Hospitals must engage individuals at all levels, from front-line providers to leadership.”

SSI’s are an important source, and may even be the most frequent healthcare-associated infection (HAI) after asymptomatic bacteriuria, representing a high burden on patients and hospitals in terms of morbidity, mortality, prolonged length of hospital stay, and additional costs.

The guidelines were published in January 2017 issue of the Journal of the American College of Surgeons (JACS).