Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

Anderson, Deverick J.; Podgorny, Kelly; Berríos-Torres, Sandra I.; Bratzler, Dale W.; Dellinger, E. Patchen; Greene, Linda; Nyquist, Ann Christine; Saiman, Lisa; Yokoe, Deborah S.; Maragakis, Lisa L.; Kaye, Keith S.

doi:10.1086/676022

Cited by 768 publications

(422 citation statements)

References 204 publications

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“…7 Most guidelines, including Therapeutic Guidelines: Antibiotic, recommend that preoperative intravenous antibiotics be given within 60 minutes of incision. 3,8,14,[31][32][33][34] More recently, the World Health Organization recommended administration within 120 minutes of incision. 35 For caesarean sections, evidence supports antimicrobial prophylaxis before cord clamping rather than afterwards.…”

Section: Resultsmentioning

confidence: 99%

Surgical antimicrobial prophylaxis

Ierano¹,

Nankervis²,

James³

et al. 2017

Aust Prescr

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Section: Resultsmentioning

confidence: 99%

Surgical antimicrobial prophylaxis

Ierano¹,

Nankervis²,

James³

et al. 2017

Aust Prescr

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“…SSI were defined using National Healthcare Safety Network criteria. 4 Prevalence rates for SSI were calculated as number of SSI per 100 procedures.…”

Section: Methodsmentioning

confidence: 99%

Seasonal Variation of Common Surgical Site Infections: Does Season Matter?

Durkin

Dicks

Baker

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To evaluate seasonal variation in the rate of surgical site infections (SSI) following commonly performed surgical procedures. DESIGN Retrospective cohort study. METHODS We analyzed 6 years (January 1, 2007, through December 31, 2012) of data from the 15 most commonly performed procedures in 20 hospitals in the Duke Infection Control Outreach Network. We defined summer as July through September. First, we performed 3 separate Poisson regression analyses (unadjusted, multivariable, and polynomial) to estimate prevalence rates and prevalence rate ratios of SSI following procedures performed in summer versus nonsummer months. Then, we stratified our results to obtain estimates based on procedure type and organism type. Finally, we performed a sensitivity analysis to test the robustness of our findings. RESULTS We identified 4,543 SSI following 441,428 surgical procedures (overall prevalence rate, 1.03/100 procedures). The rate of SSI was significantly higher during the summer compared with the remainder of the year (1.11/100 procedures vs 1.00/100 procedures; prevalence rate ratio, 1.11 [95% CI, 1.04–1.19]; P =.002). Stratum-specific SSI calculations revealed higher SSI rates during the summer for both spinal (P =.03) and nonspinal (P =.004) procedures and revealed higher rates during the summer for SSI due to either gram-positive cocci (P =.006) or gram-negative bacilli (P =.004). Multivariable regression analysis and sensitivity analyses confirmed our findings. CONCLUSIONS The rate of SSI following commonly performed surgical procedures was higher during the summer compared with the remainder of the year. Summer SSI rates remained elevated after stratification by organism and spinal versus nonspinal surgery, and rates did not change after controlling for other known SSI risk factors.

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“…2 Surgical-site infections complicate 2 to 5% of all surgical procedures and 5 to 12% of cesarean deliveries. 3–6 Infection occurring after delivery places an extra burden on the new mother and may impair mother–infant bonding and breast-feeding. The average attributable hospital cost per surgical-site infection after cesarean delivery is estimated to be $3,529.…”

mentioning

confidence: 99%

A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery

et al. 2016

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BACKGROUND Preoperative skin antisepsis has the potential to decrease the risk of surgical-site infection. However, evidence is limited to guide the choice of antiseptic agent at cesarean delivery, which is the most common major surgical procedure among women in the United States. METHODS In this single-center, randomized, controlled trial, we evaluated whether the use of chlorhexidine–alcohol for preoperative skin antisepsis was superior to the use of iodine–alcohol for the prevention of surgical-site infection after cesarean delivery. We randomly assigned patients undergoing cesarean delivery to skin preparation with either chlorhexidine–alcohol or iodine–alcohol. The primary outcome was superficial or deep surgical-site infection within 30 days after cesarean delivery, on the basis of definitions from the Centers for Disease Control and Prevention. RESULTS From September 2011 through June 2015, a total of 1147 patients were enrolled; 572 patients were assigned to chlorhexidine–alcohol and 575 to iodine–alcohol. In an intention-to-treat analysis, surgical-site infection was diagnosed in 23 patients (4.0%) in the chlorhexidine–alcohol group and in 42 (7.3%) in the iodine–alcohol group (relative risk, 0.55; 95% confidence interval, 0.34 to 0.90; P = 0.02). The rate of superficial surgical-site infection was 3.0% in the chlorhexidine–alcohol group and 4.9% in the iodine–alcohol group (P = 0.10); the rate of deep infection was 1.0% and 2.4%, respectively (P = 0.07). The frequency of adverse skin reactions was similar in the two groups. CONCLUSIONS The use of chlorhexidine–alcohol for preoperative skin antisepsis resulted in a significantly lower risk of surgical-site infection after cesarean delivery than did the use of iodine–alcohol. (Funded by the National Institutes of Health and Washington University School of Medicine in St. Louis; ClinicalTrials.gov number, NCT01472549.)

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Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

Cited by 768 publications

References 204 publications

Surgical antimicrobial prophylaxis

Surgical antimicrobial prophylaxis

Seasonal Variation of Common Surgical Site Infections: Does Season Matter?

A Randomized Trial Comparing Skin Antiseptic Agents at Cesarean Delivery

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