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May 2014
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SHEA, IDSA Publish Strategies to Prevent SSIs
Surgical site infections (SSIs) are the most common and costly healthcare-associated infection (HAI) in the United States. New evidence-based recommendations from the Society for Healthcare Epidemiology of America (SHEA) and IDSA provide a framework for healthcare institutions to prioritize and implement strategies to reduce the number of infections.

The guidelines are published in the June issue of Infection Control and Hospital Epidemiology and were produced in a collaborative effort by SHEA, IDSA, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission. The new practice recommendations are a part of Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates.

SSIs occur in as many as 5 percent of patients undergoing inpatient surgery, amounting to approximately 160,000-300,000 SSI cases each year in the U.S. However, as many as 60 percent of SSIs are preventable by using evidence-based guidelines. Each case is associated with at least seven days of prolonged hospitalization, accounting for at least $3.5 billion in healthcare expenditures annually.

"The evidence-based recommendations are broader and more inclusive than other clinical guidelines and include 15 strategies for prevention that go beyond standard practices required by the government or other national organizations," said Deverick Anderson, MD, MPH, co-lead author of the guidelines.

"Formal recommendations can be limited if they rely exclusively on randomized control trial supporting data," said Keith Kaye, MD, MPH, co-lead author of the guidelines. "The current Compendium details strategies that incorporate information from a wider variety of study designs to emulate ‘real-world’ scenarios in order to provide practical recommendations for SSI prevention and surveillance."

Below are key strategies included in the guidance:
  • Antimicrobial pre- and post- operative therapy: Healthcare professionals should adhere to appropriate antimicrobial prescribing practices before and after the surgery to optimize outcomes.
  • Preparation and monitoring protocols: Following protocols for proper hair removal, preoperative skin disinfection, and control of blood glucose levels in cardiac patients provides additional methods to help reduce SSIs.   
  • Postoperative surveillance: Because the indirect method of SSI surveillance is both reliable and specific, healthcare professionals are urged to use this approach and review microbiology reports, patient medical records, surgeon and patient surveys, and screen for readmission or return to the operating room in an effort to prevent SSIs.
The updated guidelines include a special section on implementation, emphasizing a team-based approach to prevention. These activities include engaging a multidisciplinary team that includes senior leadership and a champion physician in a culture of safety; educating surgical teams, senior leadership, and patients and families on prevention techniques; executing with a focus on reducing barriers and improving adherence with evidence-based practices to lower the risk of SSIs; and evaluating tools, practices and long-term SSI rates.

A total of seven compendium articles will be published in the May through August issues of Infection Control and Hospital Epidemiology including guidelines on strategies to prevent Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA) infections, central line-associated bloodstream infections, and ventilator-associated pneumonia, and an article focused on hand hygiene improvement strategies.

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