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

Doi : 10.1016/S1473-3099(16)30402-9

Benedetta Allegranzi, DrMD ^a,^⁎ , Bassim Zayed, MD ^a, Peter Bischoff, MD ^b, N Zeynep Kubilay, MD ^a, Stijn de Jonge, MD ^c, Fleur de Vries, MD ^c, Stacey M Gomes, MS ^d, Sarah Gans, MD ^c, Elon D Wallert, BSc ^c, Xiuwen Wu, MD ^e, Mohamed Abbas, MD ^f, Marja A Boermeester, ProfMD ^c, E Patchen Dellinger, ProfMD ^g, Matthias Egger, ProfMD ^h, Petra Gastmeier, ProfMD ^b, Xavier Guirao, MD ⁱ, Jianan Ren, ProfMD ^e, Didier Pittet, ProfMD ^f,^j, Joseph S Solomkin, ProfMD ^d,^k
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 Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China

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

^g Department of Surgery, University of Washington, Seattle, WA, USA

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

ⁱ Parc Taulí Hospital Universitari, Barcelona, Spain

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

^k 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 the most common health-care-associated infections in developing countries, but they also represent a substantial epidemiological burden in high-income countries. The prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations in national guidelines have been identified. Considering the prevention of SSIs as a priority for patient safety, WHO has developed evidence-based and expert consensus-based recommendations on the basis of an extensive list of preventive measures. We present in this Review 16 recommendations specific to the intraoperative and postoperative periods. The WHO recommendations were developed with a global perspective and they take into account the balance between benefits and harms, the evidence quality level, cost and resource use implications, and patient values and preferences.

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Introduction

Recommendation 1: perioperative oxygenation

Recommendation 2: maintaining normal body temperature (normothermia)

Recommendation 3: use of intensive protocols for perioperative blood glucose control

Recommendation 4: maintenance of adequate circulating volume control (normovolaemia)

Recommendations 5 and 6: drapes and gowns

Recommendation 7: wound-protector devices

Recommendations 8 and 9: incisional wound irrigation

Recommendation 10: prophylactic negative-pressure wound therapy

Recommendation 11: antimicrobial-coated sutures

Recommendation 12: laminar airflow ventilation systems in the context of operating room ventilation

Recommendations 13 and 14: antimicrobial prophylaxis in the presence of a drain and optimal timing for wound drain removal

Recommendation 15: wound dressings

Recommendation 16: postoperative surgical antibiotic prophylaxis prolongation

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Vol 16 - N° 12

P. e288-e303 - décembre 2016 Retour au numéro

Article précédent

New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective
Benedetta Allegranzi, Peter Bischoff, Stijn de Jonge, N Zeynep Kubilay, Bassim Zayed, Stacey M Gomes, Mohamed Abbas, Jasper J Atema, Sarah Gans, Miranda van Rijen, Marja A Boermeester, Matthias Egger, Jan Kluytmans, Didier Pittet, Joseph S Solomkin, WHO Guidelines Development Group †

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

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