Not all practices in place to prevent SSIs are necessary or evidence based
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Key takeaways:
- Not all practices in place to prevent SSIs are proven necessary.
- Practices that should continue include giving patients antimicrobial prophylaxis and unpacking surgical tools as close to use as possible.
Some common practices to prevent surgical site infections may not be necessary because no studies have shown benefits, according to a preconference presentation before the ESCMID Global Congress.
“I’ve had an interest in surgical site infections (SSIs) and operating theater practice for some years,” Hilary Humphreys, MD, a professor of clinical microbiology in the University of Medicine and Health Sciences at the Royal College of Surgeons in Ireland, told Healio, which prompted his presentation.
During the presentation, Humphreys reviewed the most current data on the many preventive measures and practices in place to prevent SSIs and discussed which may be outdated or less useful.
“A few have some evidence or a rational base/biological plausibility to them, but others are traditional, eg, leaving a patient with infection to last on the list of operations,” he said. “However, it is important for all in the operating theater to realize and understand that this is a high-risk environment for patients, and the highest standards of professionalism are required in this setting.”
According to Humphreys, one example of an unnecessary practice is patients removing their jewelry before surgery — unless this is done for security reasons or because the jewelry is located near the operation site. Another example discussed was the recommendation to have a nondisinfectant or disinfectant shower before surgery. According to Humphreys, there are currently no studies showing that this prevents or reduces SSIs.
“However, expert opinion is to encourage patients to shower/bathe before surgery for personal hygiene reasons, or to consider using alternatives (eg, alcohol/cleansing wipes) immediately before operation if patients are unable to shower or bathe,” he said in a press release.
On the other end of the spectrum, however, are some practices that are important for preventing SSIs and scientifically backed. One quick example is the uncovering or unpacking of surgical instruments as close as possible to when they will be used. This, Humphreys explained, will prevent the instruments from becoming contaminated before the surgeon uses them.
Another important consideration for preventing SSIs is the use of antibiotic prophylaxis. Humphreys shared data from a recent retrospective cohort study from Switzerland, during which 117,348 patients receiving cefuroxime were assessed.
According to the study, the overall SSI rate was 2.4%. However, this varied depending on when patients received their antibiotics before the surgery — the SSI rate for patients who received cefuroxime 0 to 30 minutes before surgery was 1.9 %; for the 31- to 60-minute group, it was 2.4%; and for the 61- to 120-minute group, it was 3.7%.
Humphreys said in a press release that these data show that cefuroxime should be administered an hour before and ideally within 10 to 25 minutes before the starting incision.
“We need to focus on those measures that are evidence based or that make clear sense,” Humphreys said. “We now also have recent examples of really good studies in surgery that can be adopted to other aspects of surgery to see if they reduce SSI.”
References:
- Humphreys H. Presentation 3891-1. Presented at: Pre-ESCMID Global Congress Day on Infection Control and Prevention; Feb. 28, 2024; online.
- Sommerstein R, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.17370.
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