New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective - 18/04/17

Doi : 10.1016/S1473-3099(16)30398-X

Benedetta Allegranzi, DrMD ^a,^⁎ , Peter Bischoff, MD ^b, Stijn de Jonge, MD ^c, N Zeynep Kubilay, MD ^a, Bassim Zayed, MD ^a, Stacey M Gomes, MS ^d, Mohamed Abbas, MD ^e, Jasper J Atema, MD ^c, Sarah Gans, MD ^c, Miranda van Rijen, MD ^f, Marja A Boermeester, ProfMD ^c, Matthias Egger, ProfMD ^g, Jan Kluytmans, ProfMD ^f,^h, Didier Pittet, ProfMD ^e,ⁱ, Joseph S Solomkin, ProfMD ^d,^j
the
WHO Guidelines Development Group^{^†}
Members of the WHO Guidelines Development Group are listed at the end of the paper

^a Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland

^b Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany

^c Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands

^d OASIS Global, Cincinnati, OH, USA

^e Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

^f Amphia Hospital Breda, Breda, Netherlands

^g Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

^h University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands

ⁱ WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

^j Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

^* Correspondence to: Dr Benedetta Allegranzi, Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, 1211 Geneva 27, Switzerland Correspondence to: Dr Benedetta Allegranzi Infection Prevention and Control Global Unit Service Delivery and Safety WHO 1211 Geneva 27 Switzerland

Summary

Surgical site infections (SSIs) are among the most preventable health-care-associated infections and are a substantial burden to health-care systems and service payers worldwide in terms of patient morbidity, mortality, and additional costs. SSI prevention is complex and requires the integration of a range of measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations of national guidelines have been identified. Given the burden of SSIs worldwide, the numerous gaps in evidence-based guidance, and the need for standardisation and a global approach, WHO decided to prioritise the development of evidence-based recommendations for the prevention of SSIs. The guidelines take into account the balance between benefits and harms, the evidence quality, cost and resource use implications, and patient values and preferences. On the basis of systematic literature reviews and expert consensus, we present 13 recommendations on preoperative preventive measures.

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Data analysis and the development of recommendations

Recommendation 1: perioperative discontinuation of immunosuppressive agents

Recommendation 2: enhanced nutritional support

Recommendation 3: preoperative bathing

Recommendations 4 and 5: decolonisation with mupirocin ointment with or without chlorhexidine gluconate body wash in nasal carriers undergoing surgery

Recommendations 6 and 7: mechanical bowel preparation and the use of oral antibiotics

Recommendation 8: hair removal

Recommendations 9 and 10: optimal timing for administration of surgical antibiotic prophylaxis (SAP)

Recommendation 11: surgical hand preparation

Recommendation 12: surgical site skin preparation

Recommendation 13: antimicrobial skin sealants

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Vol 16 - N° 12

P. e276-e287 - décembre 2016 Retour au numéro

Article précédent

Cost-effectiveness analysis of pre-exposure prophylaxis for HIV-1 prevention in the Netherlands: a mathematical modelling study
Brooke E Nichols, Charles A B Boucher, Marc van der Valk, Bart J A Rijnders, David A M C van de Vijver

| Article suivant

New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective
Benedetta Allegranzi, Bassim Zayed, Peter Bischoff, N Zeynep Kubilay, Stijn de Jonge, Fleur de Vries, Stacey M Gomes, Sarah Gans, Elon D Wallert, Xiuwen Wu, Mohamed Abbas, Marja A Boermeester, E Patchen Dellinger, Matthias Egger, Petra Gastmeier, Xavier Guirao, Jianan Ren, Didier Pittet, Joseph S Solomkin, WHO Guidelines Development Group †

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New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective - 18/04/17

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