18 May 2023 • 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 based on Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update, published in the journal Infection Control and Healthcare Epidemiology.

Experts found no evidence that continuing antibiotics after a patient’s incision has been closed, even if it has drains, prevents surgical site infections. Other recommendations include:

• Obtain a full allergy history from patients who self-report penicillin allergy
• For high-risk procedures, especially orthopedic and cardiothoracic surgeries, decolonize patients with an anti-staphylococcal agent in the pre-operative setting. Decolonization, which was elevated to an essential practice in this guidance, can reduce post-operative S. aureus infections.
• For patients with an elevated blood glucose level, monitor and maintain post-operative blood glucose levels between 110 and 150 mg/dL regardless of diabetes status. Higher glucose levels in the post-operative setting are associated with higher infection rates
• Use antimicrobial prophylaxis before elective colorectal surgery. Mechanical bowel preparation without use of oral antimicrobial agents has been associated with significantly higher rates of surgical site infection and anastomotic leakage.
• 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.

“Many surgical site infections are preventable,” said Michael S. Calderwood, MD, MPH, lead author on the updated guidelines. “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.”

Source: Physician's Weekly | Read full story