Guideline for Prevention of Surgical Site Infection, 1999,☆☆,,★★

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Abstract

EXECUTIVE SUMMARY

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)’s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1, 2 Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis. Part II, “Recommendations for Prevention of Surgical Site Infection,” represents the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs.3 Whenever possible, the recommendations in Part II are based on data from well-designed scientific studies. However, there are a limited number of studies that clearly validate risk factors and prevention measures for SSI. By necessity, available studies have often been conducted in narrowly defined patient populations or for specific kinds of operations, making generalization of their findings to all specialties and types of operations potentially problematic. This is especially true regarding the implementation of SSI prevention measures. Finally, some of the infection control practices routinely used by surgical teams cannot be rigorously studied for ethical or logistical reasons (e.g., wearing vs not wearing gloves). Thus, some of the recommendations in Part II are based on a strong theoretical rationale and suggestive evidence in the absence of confirmatory scientific knowledge. It has been estimated that approximately 75% of all operations in the United States will be performed in “ambulatory,” “same-day,” or “outpatient” operating rooms by the turn of the century.4 In recommending various SSI prevention methods, this document makes no distinction between surgical care delivered in such settings and that provided in conventional inpatient operating rooms. This document is primarily intended for use by surgeons, operating room nurses, postoperative inpatient and clinic nurses, infection control professionals, anesthesiologists, healthcare epidemiologists, and other personnel directly responsible for the prevention of nosocomial infections. This document does not:

  • Specifically address issues unique to burns, trauma, transplant procedures, or transmission of bloodborne pathogens from healthcare worker to patient, nor does it specifically address details of SSI prevention in pediatric surgical practice. It has been recently shown in a multicenter study of pediatric surgical patients that characteristics related to the operations are more important than those related to the physiologic status of the patients.5 In general, all SSI prevention measures effective in adult surgical care are indicated in pediatric surgical care.

  • Specifically address procedures performed outside of the operating room (e.g., endoscopic procedures), nor does it provide guidance for infection prevention for invasive procedures such as cardiac catheterization or interventional radiology. Nonetheless, it is likely that many SSI prevention strategies also could be applied or adapted to reduce infectious complications associated with these procedures.

  • Specifically recommend SSI prevention methods unique to minimally invasive operations (i.e., laparoscopic surgery). Available SSI surveillance data indicate that laparoscopic operations generally have a lower or comparable SSI risk when contrasted to open operations.6, 7, 8, 9, 10, 11 SSI prevention measures applicable in open operations (e.g., open cholecystectomy) are indicated for their laparoscopic counterparts (e.g., laparoscopic cholecystectomy).

  • Recommend specific antiseptic agents for patient preoperative skin preparations or for healthcare worker hand/forearm antisepsis. Hospitals should choose from products recommended for these activities in the latest Food and Drug Administration (FDA) monograph. 12

Section snippets

A. INTRODUCTION

Before the mid-19th century, surgical patients commonly developed postoperative “irritative fever,” followed by purulent drainage from their incisions, overwhelming sepsis, and often death. It was not until the late 1860s, after Joseph Lister introduced the principles of antisepsis, that postoperative infectious morbidity decreased substantially. Lister’s work radically changed surgery from an activity associated with infection and death to a discipline that could eliminate suffering and

A. RATIONALE

The Guideline for Prevention of Surgical Site Infection, 1999, provides recommendations concerning reduction of surgical site infection risk. Each recommendation is categorized on the basis of existing scientific data, theoretical rationale, and applicability. However, the previous CDC system for categorizing recommendations has been modified slightly.

Category I recommendations, including IA and IB, are those recommendations that are viewed as effective by HICPAC and experts in the fields of

Acknowledgements

The Hospital Infection Control Practices Committee thanks the following subject-matter experts for reviewing a preliminary draft of this guideline: Carol Applegeet, RN, MSN, CNOR, CNAA, FAAN; Ona Baker, RN, MSHA; Philip Barie, MD, FACS; Arnold Berry, MD; Col. Nancy Bjerke, BSN, MPH, CIC; John Bohnen, MD, FRCSC, FACS; Robert Condon, MS, MD, FACS; E. Patchen Dellinger, MD, FACS; Terrie Lee, RN, MS, MPH, CIC; Judith Mathias, RN; Anne Matlow, MD, MS, FRCPC; C. Glen Mayhall, MD; Rita McCormick, RN,

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  • Cited by (0)

    Reprint requests: SSI Guideline, Hospital Infections Program, Mailstop E-69, Center for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333. The “Guideline for Prevention of Surgical Site Infection, 1999” is available online at www.cdc.gov/ncidod/hip.

    ☆☆

    Published simultaneously in Infection Control and Hospital Epidemiology; AJIC: American Journal of Infection Control 1999;27:97-134; and the Journal of Surgical Outcomes.

    Dr. Mangram is currently affiliated with the University of Texas Medical Center, Houston, Texas.

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