Prevention of Surgical-Site Infection (SSI) Clinical Practice Guidelines (2019)

Asia Pacific Society of Infection Control (APSIC)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

December 03, 2019

The guidelines on preventing surgical-site infection (SSI) were released on November 12, 2019, by the Asia Pacific Society of Infection Control (APSIC).[1]

Surveillance

Perform surveillance of SSIs using accepted international methodology.

Preoperative Preventive Measures

It is necessary for patients who will undergo surgery to have at least one preoperative bath with soap (antimicrobial or nonantimicrobial).

A combination of mechanical bowel preparation and oral antibiotic preparation is recommended for all elective colorectal surgery in adults.

Hair removal should be avoided unless hair interferes with the operative procedure. If hair removal is necessary, a razor should be avoided, and an electric clipper should be used. No recommendation is made regarding the timing of hair removal by clipper.

Hospitals should evaluate their SSI rate, Staphylococcus aureus and methicillin-resistant S aureus (MRSA) rates, and mupirocin resistance rate, if available, to determine whether implementation of a screening program is appropriate.

Patients undergoing cardiothoracic and orthopedic surgery with known nasal carriage of S aureus should receive perioperative intranasal application of mupirocin 2% ointment, with or without a combination of chlorhexidine body wash.

Surgical hand preparation is to be performed either by scrubbing with a suitable antiseptic soap and water or by using a suitable alcohol-based hand rub (ABHR) before sterile gown and gloves are donned. ABHRs used in surgical hand preparation should comply with EN 12791 or ASTM E-1115 standards.

Where the quality of water used is not assured, use of an ABHR is recommended.

Alcohol-based skin antiseptic preparations should be used, unless contraindicated.

Administration of prophylactic antimicrobials should be performed only when indicated. It should take place within 1 hour before incision for all antimicrobials except vancomycin and fluoroquinolones, for which it should take place within 2 hours before incision. Redosing should be considered to maintain adequate tissue levels on the basis of on agent half-life. A single dose of a prophylactic antimicrobial is adequate for most surgical procedures.

Underweight patients undergoing major surgical procedures, especially oncologic and cardiovascular operations, may benefit from the administration of oral or enteral multiple nutrient-enhanced nutritional formulas for the purpose of preventing SSI.

Preoperative hemoglobin A1c levels should be below 8%.

Intraoperative Preventive Measures

Maintain perioperative normothermia by using active warming devices.

Hemodynamic goal-directed therapy is recommended to reduce SSI.

There is insufficient evidence to recommend for or against saline irrigation of incisional wounds before closure for the purpose of preventing SSI. Avoid using antimicrobial agents to irrigate incisional wounds before closure to reduce the risk of SSI.

Where there are high SSI rates in clean surgical procedures in spite of basic preventive measures, individual centers may consider the use of antimicrobial-impregnated sutures.

When using adhesive incise drapes for surgery, do not use non-iodophor-impregnated drapes; they may increase the risk of SSI. In orthopedic and cardiac surgical procedures where adhesive incise drapes are used, consider using an iodophor-impregnated incise drape, unless the patient has an iodine allergy or other contraindication.

Careful evaluation of wound protectors must be done before the use of wound protectors is introduced as a routine measure to reduce SSI.

Do not apply vancomycin powder into the surgical site for prevention of SSI.

Installation of laminar airflow is not required in new or renovated operating rooms to prevent SSI.

Postoperative Wound Management

Primary vacuum dressings or negative-pressure wound therapy (ie, for clean-contaminated and contaminated surgical procedures) and silver-based dressings have mixed results; individualized decisions on their use are suggested. Routine use for prevention of SSI is not recommended.

For more information, please go to Wound Infection.

For more Clinical Practice Guidelines, please go to Guidelines.

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