WHO guidelines for prevention of surgical site infections: intra- and post-operative measures
In addition to pre-operative prevention measures, intra- and post-operative SSI prevention strategies have been summarised by the World Health Organisation as a published review (Lancet Infect Dis 2016; 16: e288–303). Each recommendation is graded according to strength (strong or conditional) and quality.
Intra- and post-operative measures for SSI prevention are summarised as sixteen recommendations, including:
(i) Adult patients undergoing general anaesthesia with endotracheal intubation for surgical procedures should receive 80% fraction of inspired oxygen intraoperatively and, if feasible, in the immediate postoperative period for 2–6 h,
(ii) Warming devices are suggested for use in the operating room and during the surgical procedure for patient body warming,
(iii) Protocols are suggested to be used for intensive perioperative blood glucose control for both diabetic and non-diabetic adult patients undergoing surgical procedures,
(iv) Goal-directed fluid therapy is suggested for use intraoperatively,
(v) Either sterile disposable non-woven or sterile reusable woven drapes and surgical gowns can be used during surgical operations,
(vi) Plastic adhesive incise drapes with or without antimicrobial properties should not be used,
(vii) Consider the use of wound-protector devices in clean-contaminated, contaminated, and dirty abdominal surgical procedures,
(viii) Consider the use of irrigation of the incisional wound with an aqueous povidone-iodine solution before closure, particularly in clean and clean-contaminated wounds,
(ix) Antibiotic incisional wound irrigation before closure should not be used,
(x) Prophylactic negative-pressure wound therapy on primarily closed surgical incisions is suggested in high-risk wounds, while taking resources into account,
(xi) Triclosan-coated sutures are suggested to be used in all types of surgery,
(xii) Laminar airflow ventilation systems should not be used for patients undergoing total arthroplasty surgery,
(xiii) Perioperative surgical antibiotic prophylaxis should not be continued because of the presence of a wound drain for the purpose of preventing SSI,
(xiv) The wound drain should be removed when clinically indicated; no evidence was found to make a recommendation on the optimal exact timing,
(xv) No type of advanced dressing should be used over a standard dressing on primarily closed surgical wounds, and
(xvi) Surgical antibiotic prophylaxis administration should not be prolonged after completion of the operation.
These recommendations are a valuable resource for hospital infection programs in developed countries. However, given the quality of evidence, conditional recommendations must be evaluated locally by stakeholders, and in the context of the patient and surgical factors most frequently encountered within an individual healthcare facility.