New recommendations state that antibiotic use should end once incisions have healed.

According to the most recent recommendations for preventing infections at the surgical site, antibiotics that are given prior to and during surgery should be stopped as soon as the patient has closed their incision. Even if a patient’s incision has drains, experts found no evidence that continuing antibiotics prevents surgical site infections. Proceeding with anti-microbials increases the patient’s risk of C. difficile contamination, which causes extreme loose bowels and antimicrobial obstruction.

“Acute Care Hospital Surgical Site Infection Prevention Strategies: 2022 Update,” distributed in the diary Contamination Control and Emergency Clinic The study of disease transmission gives proof-based methodologies to forestall diseases for a wide range of medical procedures from top specialists from five clinical associations driven by the general public for medical services. The study of disease transmission in America

“Keeping patients safe during and after surgeries requires that health care professionals are aware of, apply, and educate others on evidence-based prevention practices.”

Michael S. Calderwood, MD, MPH, Chief Quality Officer at Dartmouth Hitchcock Medical Center in Lebanon, 

“Numerous careful site contaminations are preventable,” said Michael S. Calderwood, MD, MPH, lead creator of the refreshed rules and Boss Quality Official at Dartmouth Hitchcock Clinical Center in Lebanon, New Hampshire. “To ensure the safety of patients before, during, and after surgery, it is essential to ensure that healthcare workers are aware of, employ, and educate others about evidence-based prevention methods.

Approximately 1% to 3% of patients undergoing inpatient surgery develop surgical site infections, which are among the most common and costly infections associated with healthcare. Compared to patients who do not have infections at the surgical site, those with infections are up to 11 times more likely to die.

Other suggestions:

  • Patients who self-report an allergy to penicillin should have their complete allergy history taken. Cefazolin, a penicillin-like cousin, can be safely administered to many patients who have self-reported an allergy rather than alternative antibiotics that are less effective against surgical infections.
  • Utilize an anti-staphylococcal agent in the pre-operative setting to decolonize patients for high-risk procedures, particularly orthopedic and cardiothoracic surgeries. Post-operative S. aureus infections can be reduced through decolonization, which has been elevated to an essential practice in this guidance.
  • For patients with a raised blood glucose level, screen and keep up with post-employable blood glucose levels somewhere in the range of 110 and 150 mg/dL, paying little heed to diabetes status. Infection rates are correlated with higher postoperative glucose levels. However, there is a risk of significantly lowering the blood glucose level and increasing the risk of stroke or death when more intensive post-operative blood glucose control is targeted at levels below 110 mg/dL.
  • Before elective colorectal surgery, take antimicrobial prophylaxis. Anastomotic leakage and surgical site infections have been linked to mechanical bowel preparation without the use of oral antimicrobial agents. Prior to elective colorectal surgery, the administration of parenteral and oral antibiotics is now regarded as an essential practice.
  • Think about bad tension dressings, particularly for stomach surgical procedures or joint arthroplasty patients. A new option was chosen to cover closed incisions with negative-pressure dressings because there is evidence that these dressings reduce surgical site infections in some patients. It is thought that dressings with negative pressure reduce fluid buildup around the wound.

The use of antiseptic wound lavage, sterile reprocessing in the operating room, specific risk factors for surgical site infections, surveillance methods, infrastructure requirements, and other guidance are among the additional topics covered in the update.

Emergency clinics might consider these extra methodologies while looking to further develop results after they have completely executed the rundown of fundamental practices. Tissue oxygenation, antimicrobial powder, and gentamicin-collagen sponges are all listed as unresolved issues in the document based on the available evidence.

More information: Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update, Infection Control and Hospital Epidemiology (2023).

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