SSI Guidelines – What’s New and What’s Not


In May of this year, the CDC published an update on Surgical Site Infections (SSI) Guidelines 1. This followed a 6-year partnership with the Healthcare Infection Control Practices Advisory Committee (HICPAC), whose clinical experts provided feedback and input. Although it was the first update on these guidelines by the CDC in nearly 18 years, and greatly anticipated by clinicians and industry alike, there was minimal fanfare surrounding it.

Some experts have responded, but awareness surrounding these changes is still relatively low, especially considering that SSI is touted as the most costly hospital-acquired infection and the number of surgical procedures in the U.S. continues to rise 2,1. This post will outline what’s changed, what hasn’t, and provide a short list of other available options.

You may recall from our earlier blog post, “SSIs and Post-Op Dressings: What’s Missing?”, the prevalence as well as the clinical and financial impact of SSIs to patients and hospitals is very significant. Therefore, implementation of the latest evidence-based guidelines to reduce this risk are vital to improving outcomes and reducing associated penalties to hospitals.

What’s New or Changed?
Most notably, a new section on prosthetic joint arthroplasty is included and likely related to the significant financial burden associated with these surgeries. SSIs are known to cost up to $26,000 (in 2002 dollars), but those involving an implant can exceed $90,0001!
Remaining changes impact recommendations across the perioperative setting 1:

  • Parenteral Antimicrobial Prophylaxis
  • Nonparenteral Antimicrobial Prophylaxis
  • Glycemic Control
  • Normothermia
  • Oxygenation
  • Antiseptic Prophylaxis
  • Transfusion of Blood Products

What’s Remained the Same?
The updated CDC guideline leaves unchanged several of the original recommendations. This is reflective of the fact that 1999 guidelines were primarily based on expert opinion and points to the outstanding lack of evidence in these areas. More than half of the statements (25 of 42) are classified as “No recommendation/unresolved issue” 3.

What other SSI Guidelines Exist?
Updated guidelines have been published in recent years by groups due to the availability of new evidence and a need to summarize the most pertinent topics:

  • American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update 4
  • “Global Guidelines for the Prevention of Surgical Site Infection” by the World Health Organization (WHO) 5

Other peer-reviewed journal articles exist detailing practical strategies that can be championed by healthcare practitioners. One favorite is the 2014 update to the SHEA/IDSA practice recommendation by Dr. Anderson et al 1.

Join us for the next Eloquest Healthcare Blog where the first part of a 2-part series on kits will be featured, discussing the benefits of how kit components and configuration can improve adherence to procedure protocol thereby improving patient outcomes.

References

  1. Healthcare Infection Control Practices Advisory Committee. The Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg published online May 2017. Doi:10.1001/jamasurg.2017.0904.
  2. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infection sin acute care hospitals: 2014 update. Infect Control Hosp Epdemiol. 2014;35:605-27.
  3. Preas MA, O’Hara L, Thom K. 2017 HICPAC-CDC Guideline for Prevention of Surgical Site Infection: What the infection preventionist needs to know. Prevention Strategist. https://apic.org/Resource_/TinyMceFileManager/Periodical_images/API-Q0414_L_SSI_Guidelines_Final.pdf. Accessed online August 25, 2017
  4. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;1:59-74.
  5. Allegranzi B, Zayed B, Bischoff P et al. New WHO Recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet. 2016;16e288-303.