What are the guideline sources, guidelines and references for Surgical site infection ?
Guideline sources The following summarized guidelines for the evaluation and management of surgical site infection (SSI) are prepared by our editorial team based on guidelines from the American Academy of Orthopaedic Surgeons (AAOS 2023; 2018), the World Society of Emergency Surgery (WSES 2020), the Asia Pacific Society of Infection Control (APSIC 2019), the American College of Obstetricians and Gynecologists (ACOG 2018), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2018; 2017), and the Infectious Diseases Society of America (IDSA 2017; 2014). 1 2 3 4 5 6 7 8 9 10 Pathway Surgical site infection Management Guidelines 1. Screening and diagnosis Surveillance for surgical site infections: https://web.pathway.md/diseases/rec1yuzE8hSJSOgIE 1/5 6/24/23, 3:14 PM Surgical site infection Pathway Obtain surveillance of SSIs using accepted international methodology. B Hospitals should evaluate their SSI, S. aureus, MRSA, and mupirocin resistant rates, if available, to determine whether implementation of a screening program is appropriate. B 2. Medical management Antibiotic therapy (indications): Consider administering systemic antimicrobial therapy in conjunction with incision and drainage in patients with SSIs associated with a significant systemic response, such as: erythema and induration extending > 5 cm from the wound edge fever > 38.5 C HR > 110 bpm WBC > 12,000 cells/ L. C Show 2 more Antibiotic therapy, choice of agent: As per IDSA 2014 guidelines: Administer a first-generation cephalosporin, or antistaphylococcal penicillin to cover MSSA in patients without risk factors for MRSA infection. B Administer vancomycin, linezolid, daptomycin, telavancin, or ceftaroline in patients at high risk of MRSA, such as patients with nasal MRSA colonization, prior MRSA infection, recent hospitalization, or recent antibiotics. B As per IDSA 2014 guidelines, administer an antibiotic agent active against Gram-negative bacteria and anaerobes (such as a cephalosporin or a fluoroquinolone) in combination with metronidazole for infections following operations on the axilla, gastrointestinal tract, perineum, or female genital tract. B 3. Surgical interventions Suture removal and wound drainage: perform suture removal plus incision and drainage in patients with SSI. B 4. Specific circumstances Patients with major extremity trauma (risk factors): Counsel patients undergoing surgery for major extremity trauma that the following factors are associated with an increased risk of SSI: tobacco use A diabetes mellitus A obesity B alcohol use of > 14 units/week B https://web.pathway.md/diseases/rec1yuzE8hSJSOgIE 2/5 6/24/23, 3:14 PM Surgical site infection Pathway hypoalbuminemia of < 36g/L B postoperative hyperglycemia of > 125 mg/dL. B Show 2 more Patients with major extremity trauma (surgery timing): consider transferring patients with open fractures to the operating room for debridement and irrigation as soon as reasonable, and ideally within 24 hours after injury. C Patients with major extremity trauma (surgical field preparation): consider performing perioperative nasal and skin (full body) decolonization of patients, when possible. E Show 2 more Patients with major extremity trauma (antibiotic prophylaxis): consider administering early antibiotics to lower the risk of deep infection in the setting of open fracture in major extremity trauma. C Show 3 more Patients with major extremity trauma (wound care): irrigate open wounds with saline (without additives) in patients with major extremity trauma. A Show 4 more Patients with major extremity trauma (negative pressure wound therapy): consider offering negative pressure wound therapy after closed fracture fixation to mitigate the risk of revision surgery or SSIs. B Show 2 more Patients with major extremity trauma (hyperbaric oxygen therapy): avoid offering hyperbaric oxygen therapy in patients with open fractures. D Patients with major extremity trauma (surgical team programs): consider implementing an orthoplastic team approach to decrease the length of stay, deep infection rate, and additional operations on bone, as well as to improve time to wound healing and time to union. C Patients undergoing orthopedic surgery: Recognize that the following factors are associated with an increased risk of infection: longer hospital stay obesity alcohol abuse depression dementia anemia congestive HF immunosuppressive agents human immunodeficiency virus/AIDS. A Show 7 more Patients undergoing gynecologic surgery, antibiotic prophylaxis: as per SOGC 2018 guidelines, administer antibiotic prophylaxis in all patients undergoing abdominal or vaginal https://web.pathway.md/diseases/rec1yuzE8hSJSOgIE 3/5 6/24/23, 3:14 PM Surgical site infection Pathway hysterectomy, A laparoscopic hysterectomy, or laparoscopically-assisted vaginal hysterectomy. B Show 4 more Patients undergoing gynecologic/obstetric procedures: As per SOGC 2018 guidelines, administer prophylactic antibiotics in all patients undergoing an induced (therapeutic) surgical abortion to reduce the risk of postabortal infection. A Show 6 more As per SOGC 2017 guidelines, consider administering prophylactic antibiotics to reduce infectious morbidity associated with repair of 3rd or 4th degree perineal injury. B Show 3 more Patients undergoing Cesarean delivery: as per SOGC 2017 guidelines, administer antibiotic prophylaxis (a single dose of a first-generation cephalosporin, or clindamycin or erythromycin in case of penicillin allergy) 15-60 minutes before skin incision in all patients undergoing elective or emergency C-section. A Patients undergoing neurosurgery: administer perioperative antimicrobial prophylaxis to prevent infections of the incision in patients undergoing neurosurgery. A Show 2 more 5. Preventative measures Preoperative bathing: advise patients undergoing surgery to have at least 1 bath with antimicrobial or non-antimicrobial soap before surgery. B Preoperative decolonization: administer perioperative intranasal mupirocin 2% ointment with or without chlorhexidine body wash in patients with known nasal carriage of S. aureus undergoing cardiothoracic or orthopedic surgery. A Preoperative oral mechanical bowel preparation: perform mechanical bowel preparation in combination with oral antibiotics in all adult patients undergoing elective colorectal surgery. A Surgical hand preparation: perform surgical hand preparation either by scrubbing with a suitable antiseptic soap and water or a suitable alcohol-based hand rub before donning sterile gown and gloves. A Show 2 more Double gloving: insufficient evidence to support the use of double gloving to prevent SSIs. I Surgical site preparation (hair removal): avoid preoperative hair removal unless hair interferes with the operative procedure. D Show 2 more Surgical site preparation (topical antiseptics): use alcohol-based skin antiseptic preparations, unless contraindicated. A Preoperative glycemic control: ensure preoperative Hgb A1C levels of < 8%. B https://web.pathway.md/diseases/rec1yuzE8hSJSOgIE 4/5 6/24/23, 3:14 PM Surgical site infection Pathway Preoperative antibiotic prophylaxis: administer prophylactic antimicrobials only if indicated. A Show 2 more Intraoperative hemodynamic control: administer intraoperative hemodynamic goal-directed therapy. A Intraoperative temperature control: As per WSES 2020 guidelines: Ensure intraoperative normothermia to reduce the rate of SSIs. A Consider using active warming devices in operating room to keep normothermia and reduce SSIs. B As per APSIC 2019 guidelines, use active warming devices to maintain perioperative normothermia. B Perioperative hyperoxygenation: do not administer perioperative hyperoxygenation to reduce the rate of SSIs. D Nutrient-enhanced nutrition: consider administering oral or enteral multiple nutrient-enhanced nutritional formulas for the prevention of SSIs in underweight patients undergoing major surgical procedures, especially oncological and cardiovascular surgeries. C Operating room ventilation: do not install laminar airflow in new or renovated operating rooms to prevent SSI. D Wound closure (timing): Consider performing delayed primary skin closure to reduce the rate of SSIs. C Consider performing delayed primary closure of a surgical incision in contaminated abdominal surgeries in high-risk patients. C Wound closure, wound cleansing: As per WSES 2020 guidelines: Insufficient evidence to recommend intraperitoneal or topic wound irrigation with antibiotics in preventing SSIs. I Insufficient evidence to recommend saline or povidone irrigation of incisional wounds before closure to prevent SSIs. I As per APSIC 2019 guidelines: Insufficient evidence to recommend for or against using saline for incisional wounds before closure to reduce the risk of SSIs. I Avoid using antimicrobial agents to irrigate incisional wounds before closure to reduce the risk of SSIs. D Wound closure (local antibiotics): do not apply vancomycin powder into the surgical site for the prevention of SSIs, including spinal surgery. D Wound closure (subcutaneous drainage): insufficient evidence to recommend SC drainage of incisional wounds before closure to prevent SSIs in high-risk patients. I Wound closure, sutures: https://web.pathway.md/diseases/rec1yuzE8hSJSOgIE 5/5