Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP, Healthcare Infection Control Practices Advisory Committee., et al.
JAMA surgery. Date of publication 2017 Aug 1;volume 152(8):784-791.
1. JAMA Surg. 2017 Aug 1;152(8):784-791. doi: 10.1001/jamasurg.2017.0904.
Centers for Disease Control and Prevention Guideline for the Prevention of
Surgical Site Infection, 2017.
Berríos-Torres SI(1), Umscheid CA(2), Bratzler DW(3), Leas B(2), Stone EC(1),
Kelz RR(2), Reinke CE(4), Morgan S(2), Solomkin JS(5), Mazuski JE(6), Dellinger
EP(7), Itani KMF(8), Berbari EF(9), Segreti J(10), Parvizi J(11), Blanchard
J(12), Allen G(13), Kluytmans JAJW(14)(15), Donlan R(1), Schecter WP(16);
Healthcare Infection Control Practices Advisory Committee.
Author information:
(1)Division of Healthcare Quality Promotion, Centers for Disease Control and
Prevention, Atlanta, Georgia.
(2)Center for Evidence-Based Practice, University of Pennsylvania Health System,
Philadelphia.
(3)College of Public Health, The University of Oklahoma Health Sciences Center,
Oklahoma City.
(4)Carolinas Healthcare System, Charlotte, North Carolina.
(5)Department of Surgery, University of Cincinnati College of Medicine,
Cincinnati, Ohio.
(6)Section of Acute and Critical Care Surgery, Washington University School of
Medicine in St Louis, Saint Louis, Missouri.
(7)American College of Surgeons Representative, University of Washington Medical
Center, Seattle.
(8)Surgical Infection Society Representative, Veterans Affairs Boston Healthcare
System, Boston University and Harvard Medical School, Boston, Massachusetts.
(9)Musculoskeletal Infection Society Representative, Mayo Clinic College of
Medicine, Rochester, Minnesota.
(10)American Academy of Orthopaedic Surgeons Representative, Rush University
Medical Center, Chicago, Illinois.
(11)American Academy of Orthopaedic Surgeons Representative, Rothman Institute,
Philadelphia, Pennsylvania.
(12)Quality Department, Littleton Adventist Hospital, Denver, Colorado.
(13)Association of Perioperative Registered Nurses Representative, New York
Methodist Hospital, Brooklyn.
(14)Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda,
the Netherlands.
(15)Julius Center for Health Sciences and Primary Care, University Medical
Center, Utrecht, the Netherlands.
(16)Department of Surgery, San Francisco General Hospital, University of
California, San Francisco.
Erratum in
JAMA Surg. 2017 Aug 1;152(8):803.
Comment in
JAMA Surg. 2017 Aug 1;152(8):791-792.
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.
DOI: 10.1001/jamasurg.2017.0904
PMID: 28467526 [Indexed for MEDLINE]
