TY - JOUR
T1 - Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017
AU - Berriós-Torres, Sandra I.
AU - Umscheid, Craig A.
AU - Bratzler, Dale W.
AU - Leas, Brian
AU - Stone, Erin C.
AU - Kelz, Rachel R.
AU - Reinke, Caroline E.
AU - Morgan, Sherry
AU - Solomkin, Joseph S.
AU - Mazuski, John E.
AU - Dellinger, E. Patchen
AU - Itani, Kamal M.F.
AU - Berbari, Elie F.
AU - Segreti, John
AU - Parvizi, Javad
AU - Blanchard, Joan
AU - Allen, George
AU - Kluytmans, Jan A.J.W.
AU - Donlan, Rodney
AU - Schecter, William P.
N1 - Funding Information:
Kelz, and Morgan and Mr Leas reported receiving funding from the Centers for Disease Control and Prevention to support the guideline development process. Dr Bratzler reported being a consultant for the Oklahoma Foundation for Medical Quality and for Telligen (a nonprofit Medicaid external quality review organization) and reported that his institution received payment for his lectures, including service on speakers’ bureaus from Premier and Janssen Pharmaceuticals. Dr Reinke reported receiving lecture fees from Covidien and reported being a paid consultant for Teleflex. Dr Solomkin reported receiving grants for clinical research from, receiving consulting fees regarding clinical trial data, serving on an advisory board for, or lecturing for honoraria from the following: Merck, Actavis, AstraZeneca, PPD, Tetraphase, Johnson & Johnson, and 3M. Dr Mazuski reported being a paid consultant for Bayer, Cubist Pharmaceuticals, Forest Laboratories, MedImmune, Merck/Merck Sharp and Dohme, and Pfizer; reported receiving lecture fees from Forest Laboratories, Merck/Merck Sharp and Dohme, and Pfizer; and reported that his institution received funding for his consultancy to AstraZeneca and grants from AstraZeneca, Bayer, Merck/MSD, and Tetraphase. Dr Dellinger reported receiving grants for clinical research from, serving on an advisory board for, or lecturing for honoraria from the following: Merck, Baxter, Ortho-McNeil, Targanta, Schering-Plough, WebEx, Astellas, Care Fusion, Durata, Pfizer, Applied Medical, Rib-X, Affinium, and 3M. Dr Itani reported that his institution received grants from Merck, Cubist, Dr Reddy’s, Sanofi Pasteur, and Trius for research trials; reported clinical advisory board membership at Forrest Pharmaceuticals; and reported payment for development of educational presentations for Med Direct and Avid Education. Dr Berbari reported that his institution received a grant from Pfizer for a research trial for which he serves as the principal investigator. Dr Segreti reported receiving lecture fees from Pfizer, Merck, and Forest Laboratories and reported owning stocks in or having stock options from Pfizer. Dr Parvizi reported being a paid consultant for Zimmer, Smith and Nephew, ConvaTec, TissueGene, CeramTech, and Medtronic; reported receiving royalties from Elsevier, Wolters Kluwer, Slack Incorporated, Data Trace Publishing, and Jaypee Brothers Medical Publishers; and reported having stock options with Hip Innovation Technologies, CD Diagnostics, and PRN. Dr Allen reported receiving lecture fees from Ethicon and royalties from Wolters Kluwer as an author for Infection Control: A Practical Guide for Healthcare Facilities. Dr Kluytmans reported being a paid consultant for 3M, Johnson & Johnson, and Pfizer. No other disclosures were reported. Funding/Support: The Centers for Disease Control and Prevention (CDC) supported the development of the guideline. The activities of Drs Umscheid, Kelz, and Morgan and Mr Leas were supported through a short-term detail under contract at CDC (10IPA1004117, 10IPA1004133, 11IPA1106551, 11IPA1106555, and 11IPA1106565).
Publisher Copyright:
© 2017 American Medical Association.
PY - 2017/8
Y1 - 2017/8
N2 - 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 200mg/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.
AB - 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 200mg/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.
UR - http://www.scopus.com/inward/record.url?scp=85019731610&partnerID=8YFLogxK
U2 - 10.1001/jamasurg.2017.0904
DO - 10.1001/jamasurg.2017.0904
M3 - Review article
C2 - 28467526
AN - SCOPUS:85019731610
SN - 2168-6254
VL - 152
SP - 784
EP - 791
JO - JAMA surgery
JF - JAMA surgery
IS - 8
ER -