Updated SHEA Guidance: Stop Antibiotics upon Closure of Incisions
Medical organizations update strategies for preventing antimicrobial-resistant surgical site infections
ARLINGTON, VA — Antibiotics administered before and during surgery should be discontinued immediately after a patient’s incision is closed, according to updated recommendations for preventing surgical site infections. Experts found no evidence that continuing antibiotics after a patient’s incision has been close—even if it has drains—prevents surgical site infections. Continuing antibiotics does increase the patient’s risk of C. difficile infection, which causes severe diarrhea, and antimicrobial resistance.
“Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update”, published in Infection Control and Healthcare Epidemiology, provides evidence-based strategies for preventing infections for all types of surgeries from top experts from five medical organizations led by the Society for Healthcare Epidemiology of America (SHEA).
“Many surgical site infections are preventable,” said Michael S. Calderwood, MD, MPH, lead author on the updated guidelines and chief quality officer at Dartmouth–Hitchcock Medical Center in Lebanon, NH. “Ensuring that healthcare personnel know, utilize, and educate others on evidence-based prevention practices is essential to keeping patients safe during and after their surgeries.”
Surgical site infections are among the most common and costly healthcare-associated infections, occurring in approximately 1–3 percent of patients undergoing inpatient surgery. Patients with surgical site infections are up to 11 times more likely to die compared to patients without such infections.
Other recommendations in the updated guidance
Obtain a full allergy history from patients who self-report penicillin allergy. Many patients with a self-reported penicillin allergy can safely receive cefazolin (analogous to penicillin) rather than alternate antibiotics that are less effective against surgical infections.
For high-risk procedures, especially orthopedic and cardiothoracic surgeries, decolonize patients with an anti-Staphylococcal agent in the preoperative setting. Decolonization, which was elevated to an essential practice in this guidance, can reduce postoperative S. aureus infections.
For patients with an elevated blood glucose level, monitor and maintain postoperative blood glucose levels between 110 and 150 mg/dL regardless of diabetes status. Higher glucose levels in the postoperative setting are associated with higher infection rates. However, more intensive postoperative blood glucose control targeting levels below 110 mg/dL has been associated with a risk of significantly lowering the blood glucose level and increasing the risk of stroke or death.
Use antimicrobial prophylaxis before elective colorectal surgery. Mechanical bowel preparation without the use of oral antimicrobial agents has been associated with significantly higher rates of surgical site infection and anastomotic leakage. The use of parenteral and oral antibiotics prior to elective colorectal surgery is now considered an essential practice.
Consider negative-pressure dressings, especially for abdominal surgery or joint arthroplasty patients. Placing negative-pressure dressings over closed incisions was identified as a new option because evidence has shown these dressings reduce surgical site infections in certain patients. Negative pressure dressings are thought to work by reducing fluid accumulation around the wound.
Additional topics covered in the update include specific risk factors for surgical site infections, surveillance methods, infrastructure requirements, use of antiseptic wound lavage, and sterile reprocessing in the operating room, among other guidance.
Hospitals may consider these additional approaches when seeking to further improve outcomes after they have fully implemented the list of essential practices. The document classifies tissue oxygenation, antimicrobial powder, and gentamicin-collagen sponges as unresolved issues according to current evidence.
Upcoming Compendium updates will cover strategies to prevent catheter-associated urinary tract infections, methicillin-resistant Staphylococcus aureus infections, and implementation strategies for the prevention of healthcare-associated infections. Strategies for preventing central line-associated bloodstream infections, ventilator and non-ventilator-associated pneumonia and events, and C. difficile infections as well as strategies to prevent healthcare-associated infections through hand hygiene were updated recently. Each Compendium article contains infection prevention strategies, performance measures, and approaches to implementation. Compendium recommendations are derived from a synthesis of systematic literature review, evaluation of the evidence, practical and implementation-based considerations, and expert consensus.
- This press release was originally published on The Society For Healthcare Epidemiology of America website