US researchers have updated recommendations for preventing surgical site infections, advising that antibiotics given before and during surgery should be stopped as soon as the incision is closed. The updated guidelines, published in the journal Infection Control and Hospital Epidemiology, found no evidence that continuing antibiotics after the incision has been closed, even if it has drains, prevents surgical site infections. However, continuing antibiotics increases the risk of C. difficile infection, which causes severe diarrhoea, and antimicrobial resistance. The study provides evidence-based strategies for preventing infections in all types of surgeries from top experts from five medical organisations led by the Society for Healthcare Epidemiology of America.
Surgical site infections are among the most common and costly healthcare-associated infections, occurring in approximately one per cent to three per cent of patients undergoing inpatient surgery, according to the researchers. Patients with surgical site infections are up to 11 times more likely to die compared to patients without such infections.
The guidelines also recommend obtaining a full allergy history from patients who self-report penicillin allergy. For high-risk procedures, especially orthopedic and cardiothoracic surgeries, patients must be decolonised with an anti-staphylococcal agent in the pre-operative setting. For patients with elevated blood glucose levels, health care personnel are advised to monitor and maintain post-operative blood glucose levels between 110 and 150 mg/dL, regardless of diabetes status. The researchers also recommend using antimicrobial prophylaxis before elective colorectal surgery and considering negative-pressure dressings, especially for abdominal surgery or joint arthroplasty patients.
“Many surgical site infections are preventable,” said Michael S. Calderwood, lead author on the updated guidelines and Chief Quality Officer at Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, US. “Ensuring that healthcare personnel know, utilise, and educate others on evidence-based prevention practices is essential to keeping patients safe during and after their surgeries.”
The updated guidelines provide a comprehensive strategy for reducing the incidence of surgical site infections, thereby decreasing healthcare costs and improving patient outcomes.