Post-surgical site. Credit: Matt & Jenn Ruff
Key points:
- New surgical guidelines say antibiotics should be discontinued immediately after a patient’s incision is closed.
- Experts found no evidence that continuing antibiotics after a patient’s incision has been closed prevents surgical site infections.
- The guidelines, updated from the previous 2014 version, provide evidence-based strategies for preventing infections for all types of surgeries.
The Society for Healthcare Epidemiology of America has released new recommendations for preventing surgical site infections, updating the 2014 guidelines. According to the updated guidelines, antibiotics administered before and during surgery should be discontinued immediately after a patient’s incision is closed.
Experts found no evidence that continuing antibiotics after a patient’s incision has been closed—even if it has drains—prevents surgical site infections. However, continuing antibiotics does increase the patient’s risk of C. difficile infection and adds to overall antibiotic resistance.
Surgical site infections are among the most common and costly healthcare-associated infections, occurring in approximately 1% to 3% of patients undergoing inpatient surgery. Patients with surgical site infections are up to 11 times more likely to die compared to patients without such infections.
“Many surgical site infections are preventable,” said Michael Calderwood, MD, lead author on the updated guidelines and Chief Quality Officer at Dartmouth Hitchcock Medical Center. “Ensuring that healthcare personnel know, utilize, and educate others on evidence-based prevention practices is essential to keeping patients safe during and after their surgeries.”
Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update provides evidence-based strategies for preventing infections for all types of surgeries from top experts from five medical organizations led by the Society for Healthcare Epidemiology of America. Additional topics covered in the update include specific risk factors for surgical site infections, surveillance methods, infrastructure requirements, use of antiseptic wound lavage, and sterile reprocessing in the operating room, among other guidance.
For example, according to the guidelines, for high-risk procedures, especially orthopedic and cardiothoracic surgeries, clinicians should decolonize patients with an anti-staphylococcal agent in the pre-operative setting. Decolonization, which was elevated to an essential practice in this guidance, can reduce post-operative S. aureus infections.
Additionally, the guidelines urge clinicians to consider negative-pressure dressings, especially for abdominal surgery or joint arthroplasty patients. Placing negative-pressure dressings over closed incisions was identified as a new option because evidence has shown these dressings reduce surgical site infections in certain patients. Negative pressure dressings are thought to work by reducing fluid accumulation around the wound.