New CDC Guideline for the Prevention of Surgical
Site Infection
This updates the 1999 original, published before formal
evidence-based guidelines were in routine use.
I
n May, the Healthcare Infec-
tion Control Practices Advi-
sory Committee (HICPAC)
of the Centers for Disease Control
and Prevention released their 2017
Guideline for the Prevention of
Surgical Site Infection (http://bit.
ly/2pJXz7l). This long-awaited
guideline updates the 1999 origi-
nal, which was published before
formal evidence-based guidelines
were in routine use and relied
heavily on expert opinion in lieu
of clinical or epidemiological
studies.
The new guideline uses a modi-
fied Grading of Recommendations,
Assessment, Development, and
Evaluation (GRADE) approach to
link the quality of evidence to the
strength of its recommendations.
The 2017 guideline offers a
targeted systematic review of the
evidence for surgical site infection
(SSI) prevention in 13 intervention
categories. The authors did not re-
evaluate several strong recom-
mendations of the 1999 guideline
that are now considered to be ac-
cepted practice. These are summa-
rized in online appendices.
Seven of the 13 intervention
categories relate specifically to
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prosthetic joint arthroplasty, which
the authors identify as procedures
in which the human and financial
burden [of SSI] is greatest. There
are few recommendations in this
section; most of the issues raised
are designated as unresolved.
Among the six interventions
that apply to all types of surgeries,
new category IA and IB recom-
mendations include a perioperative
blood glucose target of less than
200 mg/dL for patients with and
without diabetes, a pre-op shower
or bath with either an antiseptic/
antimicrobial soap or plain soap,
the use of an alcohol-based anti-
septic skin prep, the perioperative
maintenance of normothermia,
and the administration of anti-
microbial prophylaxis for cesar-
Photo Outpatient Surgery Magazine.
ean sections before skin incision
rather than after the cord is
clamped.
Unresolved issues include the
optimal timing and number of
pre-op baths or showers, the need
for additional doses of an antimi-
crobial agent during lengthy sur-
geries, the use of intraoperative
antibiotic irrigation solutions, and prior to implant.Betsy Todd,
the soaking of prosthetics in anti- MPH, RN, CIC, AJN Clinical
microbial or antiseptic solutions Editor
AJN August 2017 Vol. 117, No. 8 17