Abstract
Purpose of Review
This review summarizes recent surgical site infection (SSI) prevention guidelines/guideline updates that are relevant to surgery and wound care after injury and reviews a sample of recent literature relevant to SSI.
Recent Findings
The quality of evidence supporting guidelines/guideline updates is quite variable. The strongest support is for appropriately timed preoperative antibiotics when indicated and for alcohol-based skin preparation before incision when feasible.
Summary
New guidelines for SSI prevention are available from the American College of Surgeons, the Centers for Disease Control, and the World Health Organization. There are recommendations common to all three reports that trauma/acute care surgeons should be aware of.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
Magill SS, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198–208.
Zimlichman E, Henderson D, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039–46.
Klevens RM, Edwards JR, et al. Estimating healthcare-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122:160–6.
•• Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017;224(1):59–74 Guidelines from the American College of Surgeon and Surgical Infection Society grouped conveniently into prehospital and hospital guidelines.
•• Berrios-Torres SI, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784–91 The Centers for Disease Control and Prevention guidelines update emphasizes recommended guidelines with the strongest evidence base.
•• Global Guidelines for the Prevention of Surgical Site Infection. I. World Health Organization. ISBN 978 92 4 154988 2© World Health Organization 2016 The World Health Organization guidelines are the most comprehensive and have the most detailed discussion of evidence underlying recommended guidelines.
de Castro Franco LM, Cota GF, Pinto TS, Ercole FF. Preoperative bathing of the surgical site with chlorhexidine for infection prevention: systematic review with meta-analysis. Am J Infect Control. 2017;45:343–9.
Privitera GP, Costa AL, Brusaferro S, Chirletti P, Crosasso P, Massimetti G, et al. Skin antisepsis with chlorhexidine versus iodine for the prevention of surgical site infection: a systematic review and meta-analysis. Am J Infect Control. 2017;45:180–9.
Henriksen NA, Deerenberg EB, Vanclauskas L, Fortelny RH, Garcia-Alamino JM, Miserez M, et al. Triclosan-coated sutures and surgical site infection in abdominal surgery: the TRISTAN review, meta-analysis, and trial sequential analysis. Hernia. 2017;21:833–41.
Sprowson AP, Jensen C, Parsons N, Partington P, Emmerson K, et al. The effect of triclosan-coated sutures on the rate of surgical site infection after hip and knee arthroplasty: a double blind randomized controlled trial of 2546 patients. Bone Joint J. 2018;100-B(3):296–302.
Mihaljevic AL, Muller TC, Kehl V, Friess H, Kleef J. Wound edge protectors in open abdominal surgery to reduce surgical site infections: a systematic review and meta-analysis. PLoS One. 2015;10(3):e0121187. https://doi.org/10.1371/journal.Pone0121187.
Pinder EM, Bottle A, Aylin P, Loeffler MD. Does laminar flow ventilation reduce the rate of infection? Bone Joint J. 2016;98-B:1262–9.
Gormly T, Markel TA, Jones H, Greeley D, Ostojic J, Clarke JH, et al. Cost-benefit analysis of different air change rates in an operating room environment. Am J Infect Control. 2017;45:1318–23.
Hsieh MC, Kuo LT, Chi CC, Huang WS, Chin CC. Pursestring closure versus conventional primary closure following stoma reversal to reduce surgical site infection rate: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2015;58:808–15.
Yamamoto M, Tanaka K, Masubuchi S, Ishii M, Hamamoto H, Suzuki S, et al. Risk factors for surgical site infection after stoma closure comparison between pursestring wound closure and conventional linear wound closure: propensity score matching analysis. Am J Surg. 2018;215:58–61.
Webster J, Alghamdi A. Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev 2015, Issue 4. Art. No.: CD006353. DOI: https://doi.org/10.1002/14651858.CD006353.pub4.
Norman G, Dumville JC,Moore ZEH, Tanner J, Christie J, Goto S. Antibiotics and antiseptics for pressure ulcers. Cochrane Database Syst Rev 2016, Issue 4. Art. No.: CD011586. DOI: https://doi.org/10.1002/14651858.CD011586.pub2.
Li Z, Zhao L, Cheng Y, Cheng N, Deng Y. Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database of Syst Rev 2018, Issue 5. Art. No.: CD010168.DOI:https://doi.org/10.1002/14651858.CD010168.pub3
Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, Blencowe N, Milne TKG, Reeves BC, Blazeby J. Dressings for the prevention of surgical site infection. Cochrane Database of Syst Rev 2016, Issue 12. Art. No.: CD003091.DOI: https://doi.org/10.1002/14651858.CD003091.pub4.
Tanner J, Dumville JC, Norman G, Fortnam M. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database of Syst Reviews 2016, Issue 1. Art. No.: CD004288. DOI: https://doi.org/10.1002/14651858.CD004288.pub3
Norman G, Atkinson RA, Smith TA, Rowlands C, Rithalia AD, Crosbie EJ, Dumville JC. Intracavity lavage and wound irrigation for prevention of surgical site infection. Cochrane Database of Syst Rev 2017, Issue 10. Art. No.: CD012234. DOI:https://doi.org/10.1002/14651858.CD012234.pub2.
Barnes S, Spencer M, Graham D, Johnson HB. Surgical wound irrigation: a call for evidence-based standardization of practice. Am J Infect Control. 2014;42:525–9.
Liu Z, Dumville JC, Norman G, Westby MJ, Blazeby J, McFarlane E, Welton NJ, O’Connor L, Cawthorne J, George RP, Crosbie EJ, Rithalia AD, Cheng HY. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2018, Issue 2. Art. No.: CD012653. DOI: https://doi.org/10.1002/14651858.CD012653.pub2.
Vincent M, Edwards P. Disposable surgical face masks for preventing surgical wound infection in clean surgery. Cochrane Database of Syst Rev 2016, Issue 4. Art. No.: CD002929. DOI: https://doi.org/10.1002/14651858.CD002929.pub3.
Liu Z,Norman G, Iheozor-Ejiofor Z,Wong JKF, Crosbie EJ,Wilson P. Nasal decontamination for the prevention of surgical site infection in Staphylococcus aureus carriers. Cochrane Database of Syst Rev 2017, Issue 5. Art. No.: CD012462. DOI:https://doi.org/10.1002/14651858.CD012462.pub2.
Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database of Syst Rev 2016, Issue 11. Art. No.: CD011426. DOI:https://doi.org/10.1002/14651858.CD011426.pub2.
Webster J, Scuffham P, Stankiewicz M, Chaboyer WP. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database of Syst Rev 2014, Issue 10. Art. No.: CD009261. DOI:https://doi.org/10.1002/14651858.CD009261.pub3.
Costa ML, Achten J, Tutton E, Petrou S, Lamb SE, Parsons NR. Effect of negative pressure wound therapy vs standard wound management on 12-month disability among adults with severe open fracture of the lower limb: the WOLFF Randomized Clinical Trial. JAMA. 2018;319(22):2280–8. https://doi.org/10.1001/jama.2018.6452.
Toon CD, Sinha S, Davidson BR, Gurusamy KS. Early versus delayed post-operative bathing or showering to prevent wound complications. Cochrane Database Syst Rev 2015, Issue 7. Art. No.: CD010075. DOI:https://doi.org/10.1002/14651858.CD010075.pub3.
Toon CD, Lusuku C, Ramamoorthy R, Davidson BR, Gurusamy KS. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Database of Syst Rev 2015, Issue 9. Art. No.: CD010259. DOI:https://doi.org/10.1002/14651858.CD010259.pub3.
Poole D, Chieregato A, Langer M, Viaggi B, Cingolani E, Malacarne P, et al. Systematic review of the literature and evidence-based recommendations for antibiotic prophylaxis in trauma: results from an Italian consensus of experts. PLoS One. 2014;9(11):e113676.
Leeds IL, Fabrizio A, Cosgrove S, Wick EC. Treating wisely: the surgeon’s role in antibiotic stewardship. Ann Surg. 2017;265(5):871–3.
Edmiston CE, Leaper D, Spencer M, Truitt K, Fauerbach LL, et al. Considering a new domain for antibiotic stewardship: topical antibiotics in the open surgical wound. Am J Infect Control. 2017;45:1259–66.
Levy SM, Lally KP, Blakely ML, Calkins CM, Dassinger MS, Duggan E, et al. Surgical wound misclassification: a multicenter evaluation. J Am Coll Surg. 2015;220(3):323–9.
Etzioni DA, Lessow CL, Lucas HD, Merchea A, Madura JA, Mahabir R, et al. Infectious surgical complications are not dichotomous: characterizing discordance between administrative data and registry data. Ann Surg. 2018;267(1):81–7.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The author declares no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Wound Care After Injury
Rights and permissions
About this article
Cite this article
Schulz, J.T. Update on Prevention of Surgical Site Infections. Curr Trauma Rep 5, 1–5 (2019). https://doi.org/10.1007/s40719-019-0157-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40719-019-0157-3