Volume 7, Number 2—April 2001
THEME ISSUE
4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections
Prevention is Primary
Preventing Surgical Site Infections: A Surgeon's Perspective
Ronald Lee Nichols
Table 1
Hospital Infection Control Practices Advisory Committee (HICPAC) Partial Recommendations for the Prevention of Surgical Site Infection-1999 (16)
| Rankings | |
|---|---|
| Category 1A | Strongly recommended for implementation and supported by well-designed experimental, clinical, or epidemiologic studies |
| Category 1B | Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and strong theoretical rationale |
| Category II | Suggested for implementation and supported by suggestive clinical or epidemiologic studies or theoretical rationale |
| No recommendation; unresolved issue. | Practices for which insufficient evidence or no consensus regarding efficacy exists |
| Recommendations | |
| Preoperative--partial and modified | |
| A. Preparation of the patient | |
| Category 1A | Treat remote infection before elective operation; postpone surgery until treated Do not remove hair from operative site unless necessary to facilitate surgery If hair is removed, do immediately before surgery, preferably with electric clippers |
| Category 1B | Control serum blood glucose perioperatively Cessation of tobacco use 30 days before surgery Do not withhold necessary blood products to prevent SSIs Shower or bath on night before operative procedure Wash incision site before performing antiseptic skin preparation with approved agent |
| Category II | Prepare skin in concentric circles from incision site Keep preoperative stay in hospital as short as possible |
| Unresolved | Improve nutritional status Use of mupirocin in nares Improve oxygenation of wound space Taper or discontinue systemic steroid use before elective surgery |
| B. Antimicrobial prophylaxis | |
| Category 1A | Select (if indicated) an antimicrobial agent with efficacy against expected pathogen Intravenous route used to ascertain adequate serum levels during operation and for at most a few hours after incision closed Before elective colorectal operations, in addition to parenteral agent, mechanically prepare the colon by use of enemas and cathartics. Administer nonabsorbable oral antimicrobial agents in divided doses on the day before the operation |
| Category 1B | Do not routinely use vancomycin for antimicrobial prophylaxis |
| SSI = surgical site infections | |
