Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

Abstract

and purpose The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing their surgical-site infection (SSI) prevention efforts. This document updates the Strategies to Prevent Surgical Site Infections in Acute Care Hospitals published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update

“…However, a theoretical rationale and some evidence of benefit do exist, and no evidence of harm has been reported. In addition, benefits of antimicrobial stewardship have been established for other important outcomes (eg, C. difficile prevention). Please refer to the “Compendium of Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update” 87 and current guidelines for surgical antibiotic prophylaxis 88 for recommendations regarding surgical antibiotic prophylaxis among patients known to be colonized with MRSA. …”

“…(See MRSA Decolonization, recommendation 2, in the Additional Approaches section. ) Please refer to the “Compendium of Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update” 87 for recommendations regarding active surveillance and decolonization for organisms other than MRSA (eg, all S. aureus ). Active surveillance with contact precautions is inferior to universal decolonization for reduction of MRSA clinical isolates in adult ICUs. (Quality of evidence: HIGH) A 43-hospital cluster-randomized trial in ICUs (REDUCE MRSA Trial) 99 directly compared (1) active surveillance for MRSA coupled with contact precautions, (2) active surveillance for MRSA coupled with contact precautions and targeted decolonization, and (3) stopping active surveillance, continuing contact precautions for known MRSA carriers, and performing universal decolonization for all ICU patients.…”

“…117 Universal nasal decolonization without nasal screening can be employed for pragmatic reasons to spare the logistics for screening for S. aureus or MRSA. Use of povidone-iodine may also be chosen for pragmatic reasons because it does not require a prescription, including prescription-related transportation needs or insurance copays that may affect patient adherence. Please refer to the “Compendium of Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update” 87 for recommendations regarding decolonization for organisms other than MRSA. Screen for MRSA and provide targeted decolonization with CHG bathing and nasal decolonization to MRSA carriers in surgical units to reduce postoperative MRSA inpatient infections. (Quality of evidence: MODERATE) Note that decolonization can be applied universally as an alternative. In a multinational trial of 33 surgical units in 10 hospitals involving 126,750 admissions, an intervention of enhanced hand hygiene plus universal screening and targeted decolonization of MRSA carriers reduced MRSA clinical cultures by 12% per month.…”

“…117 Universal nasal decolonization without nasal screening can be employed for pragmatic reasons to spare the logistics for screening for S. aureus or MRSA. Use of povidone-iodine may also be chosen for pragmatic reasons because it does not require a prescription, including prescription-related transportation needs or insurance copays that may affect patient adherence. Please refer to the “Compendium of Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2022 Update” 87 for recommendations regarding decolonization for organisms other than MRSA. …”

Optimizing the Relationship Between Perioperative Personnel and Infection Preventionists to Reduce Surgical Site Infections

“…7 A variety of factors affect the SSI occurrence rates, including patient risk factors (eg, age, glucose levels, weight), perioperative practices (eg, skin preparation, perioperative antibiotic choice and timing), OR characteristics (eg, ventilation, traffic, decontamination practices), disinfection and sterilization of surgical equipment, and provision of care that meets quality standards. 8 As the number of surgical procedures performed in the United States increases, so too does the importance of preventing SSIs. 9 Many states have laws requiring hospitals to report their SSI rates, which are then made publicly available online to assist patients in their decision making regarding choice of surgeons and hospitals.…”