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Surgical site infection

Key sources
The following summarized guidelines for the evaluation and management of surgical site infection are prepared by our editorial team based on guidelines from the American Academy of Orthopaedic Surgeons (AAOS 2023; 2018), the World Society of Emergency Surgery (WSES 2020), the Asia Pacific Society of Infection Control (APSIC 2019), the American College of Obstetricians and Gynecologists (ACOG 2018), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2018; 2017), and the Infectious Diseases Society of America (IDSA 2017; 2014).
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Guidelines

1.Screening and diagnosis

Surveillance for surgical site infections
Obtain surveillance of SSIs using accepted international methodology.
B
Hospitals should evaluate their SSI, S. aureus, MRSA, and mupirocin resistant rates, if available, to determine whether implementation of a screening program is appropriate.
B
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2.Medical management

Antibiotic therapy, indications: consider administering systemic antimicrobial therapy in conjunction with incision and drainage in patients with SSIs associated with a significant systemic response, such as:
erythema and induration extending > 5 cm from the wound edge
fever > 38.5 °C
HR > 110 bpm
WBC > 12,000 cells/µL
C
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  • Antibiotic therapy (choice of agent)

3.Surgical interventions

Suture removal and wound drainage: perform suture removal plus incision and drainage in patients with SSI.
B

4.Specific circumstances

Patients with major extremity trauma, risk factors: counsel patients undergoing surgery for major extremity trauma that the following factors are associated with an increased risk of SSI:
tobacco use
A
diabetes mellitus
A
obesity
B
alcohol use of > 14 units/week
B
hypoalbuminemia of < 36g/L
B
postoperative hyperglycemia of > 125 mg/dL.
B
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  • Patients with major extremity trauma (surgery timing)

  • Patients with major extremity trauma (surgical field preparation)

  • Patients with major extremity trauma (antibiotic prophylaxis)

  • Patients with major extremity trauma (wound care)

  • Patients with major extremity trauma (negative pressure wound therapy)

  • Patients with major extremity trauma (hyperbaric oxygen therapy)

  • Patients with major extremity trauma (surgical team programs)

  • Patients undergoing orthopedic surgery

  • Patients undergoing gynecologic surgery (antibiotic prophylaxis)

  • Patients undergoing gynecologic/obstetric procedures

  • Patients undergoing Cesarean delivery

  • Patients undergoing neurosurgery

5.Preventative measures

Preoperative bathing: advise patients undergoing surgery to have at least 1 bath with antimicrobial or non-antimicrobial soap before surgery.
B

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  • Preoperative decolonization

  • Preoperative oral mechanical bowel preparation

  • Surgical hand preparation

  • Double gloving

  • Surgical site preparation (hair removal)

  • Surgical site preparation (topical antiseptics)

  • Preoperative glycemic control

  • Preoperative antibiotic prophylaxis

  • Intraoperative hemodynamic control

  • Intraoperative temperature control

  • Perioperative hyperoxygenation

  • Nutrient-enhanced nutrition

  • Operating room ventilation

  • Wound closure (timing)

  • Wound closure (wound cleansing)

  • Wound closure (local antibiotics)

  • Wound closure (subcutaneous drainage)

  • Wound closure (sutures)

  • Wound closure (wound strips and adhesives)

  • Wound closure (wound protectors and drapes)

  • Postoperative wound care (negative pressure wound therapy)

  • Postoperative wound care (silver-based dressings)