Updated guidelines that detail the latest evidence to prevent surgical site infections before, during and after surgery have been published in the Journal of the American College of Surgeons.
“The main areas in which there is new evidence to support new or different guidelines are: blood glucose control is now recommended for all patients, regardless of diabetic status; adherence must be high to all components of surgical site infection reduction bundles to achieve maximum benefit; and, with some exceptions (including joint arthroplasty), prophylactic antibiotics should be stopped at the time of incision closure,” Kristen A. Ban, MD, told Healio.com/Orthopedics. “There are still areas of controversy, including surgical attire, where there is insufficient high-quality data to support guidelines.”
As an update of previously published guidelines, researchers drafted the guidelines based on evidence provided by literature.
According to the guidelines, patients should be counseled by surgeons to completely refrain from smoking, which presents a higher risk for surgical site infections, for a minimum of 4 weeks to 6 weeks prior to elective surgery. Researchers noted, compared with long-term blood glucose maintenance, short-term blood glucose control before, during and after surgery is more important. Blood sugar control should also be expanded to all patients, according to research, regardless of diabetic status.
Although studies of individual procedures have shown promising results with the use of topical and local antibiotics to reduce infections, researchers noted more randomized clinical trials of a wider range of procedures are needed before more widespread use or formal recommendations can be identified. Researchers also noted there was considerable evidence to support the use of antibiotic sutures to decrease surgical site infections.
Other guideline recommendations included only removing hair in the surgical site if it would interfere with surgery and the practice of routine double gloving. According to researchers, early showering after surgery can also be encouraged at the surgeon’s discretion, since previously published studies have shown no difference in the risk of surgical site infections between patients who shower as early as 12 hours after surgery and patients who delay showering for more than 48 hours. – by Casey Tingle
Disclosure: Ban reports no relevant financial disclosures.