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 2
Changes in CDC surgical site infections prevention guidelines, 1999 (16)
| 1985 | 1999 |
|---|---|
| Category 1 | Category 1A |
| Category II | Category 1B |
| Category III | Category II or no recommendation; unresolved |
| Preoperative hair removal | |
| Do not remove hair unless it will interfere with the operation | Recommendation unchanged |
| Category II | Category 1A |
| If removed, remove by clipping or use of a depilatory, not by shaving | If removed, preferably remove immediately before the operation with electric clippers |
| Category II | Category 1A |
| Preoperative shower or bath | |
| Patient should bathe with antimicrobial soap the night before an elective operation | Require patients to shower or bathe with an antiseptic agent at least the night before surgery |
| Category III | Category 1B |
| Preoperative hand and forearm antisepsis | |
| Perform surgical scrub for at least 5 minutes before first operation of day | Perform surgical scrub for at least 2-5 minutes with an appropriate antiseptic |
| Category 1 | Category 1B |
| Between consecutive operations perform surgical scrub 2 to 5 minutes | |
| Category II | |
| After scrub, dry hands with sterile towel, don sterile gown and gloves | After scrub, keep hands up and away from body; dry hands with sterile towel; don sterile gown and gloves |
| Category 1 | Category 1B |
| Preoperative patient preparation | |
| Treat and control all bacterial infections before operation | Identify and treat all remote infections before elective operation |
| Category 1 | Category 1A |
| The hospital stay should be as short as possible | Keep hospital stay as short as possible |
| Category II | Category II |
| If patient is malnourished, enteral or parenteral nutrition should be given | No recommendation to use nutritional support solely to prevent surgical site infection |
| Category II | Unresolved |
| Preoperative antimicrobial prophylaxis | |
| Use for operations with high infection rate or for those with severe or life-threatening consequences if infection occurs | Administer antimicrobial agent only when indicated and select based on published recommendations for a specific operation and efficacy against most common pathogens |
| Category 1 | Category 1A |
| Select antimicrobial agents that are safe and effective | |
| Category 1 | |
| Start parenteral IV antimicrobial agents shortly before operation and discontinue shortly afterward | Administer antimicrobial agents by IV timed to ensure bactericidal serum and tissue levels when incision made |
| Category 1 | Category 1A |
| Maintain therapeutic levels during operation and, at most, a few hours after closure | |
| Category 1A | |
| Before colorectal elective operations, in addition to IV antimicrobial drugs, mechanically prepare the colon with enemas and cathartic agents; administer nonabsorbable oral antimicrobial agents in individual doses the day before surgery | |
| Category 1A | |
| For cesarean sections in patients at high risk administer IV antimicrobial agent immediately after cord is clamped | |
| Category 1A | |
| Do not routinely use vancomycin for prophylaxis | |
| Category 1B | |
