_______________________________________________________________ Healthcare-Associated Infections
LEVEL IA and IB RECOMMENDATIONS FOR THE PREVENTION OF SURGICAL SITE INFECTIONS a 1999 Guideline 2017 Additions Preoperative
Whenever possible, identify and treat all infections remote to the surgical site before elective operation, and postpone elective operations on patients with remote site infections until the infection has resolved. Do not remove hair preoperatively unless the hair at or around the incision site will interfere with the operation. If hair is removed, remove immediately before the operation, preferably with electric clippers. Adequately control serum blood glucose levels in all diabetic patients and particularly avoid hyperglycemia perioperatively. Encourage tobacco cessation. At minimum, instruct patients to abstain for at least 30 days before elective operation from smoking cigarettes, cigars, pipes, or any other form of tobacco consumption (e.g., chewing/dipping). Do not withhold necessary blood products from surgical patients as a means to prevent surgical site infection. Thoroughly wash and clean at and around the incision site to remove gross contamination before performing antiseptic skin preparation. Use an appropriate antiseptic agent for skin preparation. Antimicrobial Prophylaxis Administer a prophylactic antimicrobial agent only when indicated, and select it based on its efficacy against the most common pathogens causing surgical site infection for a specific operation and published recommendations. Administer by the intravenous route the initial dose of prophylactic antimicrobial agent, timed such that a bactericidal concentration of the drug is established in serum and tissues when the incision is made. Maintain therapeutic levels of the agent in serum and tissues throughout the operation and until, at most, a few hours after the incision is closed in the operating room. Before elective colorectal operations, in addition to above recommendation, mechanically prepare the colon by use of enemas and cathartic agents. Administer nonabsorbable oral antimicrobial agents in divided doses.
Implement perioperative glycemic control; use serum blood glucose target (upper) level <200 mg/dL in diabetic and nondiabetic patients. Maintain perioperative normothermia. Perform intraoperative skin preparation with an alcohol-based antiseptic agent, unless contraindicated.
In all cesarean sections, administer the appropriate parenteral prophylactic antimicrobial agent prior to skin incision. In clean and clean-contaminated procedures, do not administer additional prophylactic antimicrobial agent doses after the surgical incision is closed in the operating room, even in the presence of a drain. Do not apply antimicrobial agents (e.g., ointments, solutions, powders) to the surgical incision for the prevention of surgical site infection. For patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation, administer increased FiO 2 both intraoperatively and postextubation in the immediate postoperative period. To optimize tissue oxygen delivery, maintain perioperative normothermia and adequate volume replacement.
Oxygenation __
Postoperative Incision Care Protect with a sterile dressing for 24 to 48 hours postoperatively an incision that has been closed primarily. Wash hands before and after dressing changes and any contact with the surgical site. __
a Level I recommendations are supported by high-to-moderate quality evidence suggesting net clinical benefits or harms, or by low-quality evidence suggesting net clinical benefits or harms, or are accepted practices supported by low-to-very low quality evidence. Source: [31] Table 10
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