Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines

Abstract

Background: Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intraabdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. Methods: The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES.Results: Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI.Conclusions: The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.

Surgical Site Infection After Emergency Abdominal Surgery in China: A Multicenter Prospective Study

“…This may be due to more contaminated incisions being irrigated than clean incisions during surgery, therefore spreading the infective microbes. The World Society for Emergency Surgery (WSES) states in the Intraoperative Surgical Site Infection Control and Prevention that there is insu cient data to support the role of irrigation of the incision with saline or polyvidone before closure in preventing SSI [21].…”

Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications

“…We did not undertake a systematic review since we were aware that there had been a number of reviews surrounding the use of antibiotic prophylaxis as well as other potential interventions to reduce SSIs. 29 ,– 50 ,– 52 ,– 86 ,– 88–93 In addition, our aim was to provide possible guidance for key stakeholder groups within LMICs based on our experiences for potential debate. We have successfully used this approach across LMICs to stimulate debate in different key disease areas and topics.…”

“…Recognized measures to reduce SSIs include surgical hand preparation, antiseptic preparation, coated sutures, wound protector devices, and negative-pressure wound dressings. 18 ,– 29 ,– 36–38 In addition, improving the quality of surgery through increased education as well as the development and monitoring of pertinent quality indicators (QIs). 39–41 Measures also include administering antimicrobial prophylaxis, which is seen as the single most effective intervention to reduce SSI rates.…”

Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study

“…Surgical site infections (SSIs) are the most common in-hospital acquired infections, adding up to 46.4% of all infections, as reported by the CDC [1]. The first site of infection, in terms of timing, is the superficial incision [2]. We must not underestimate this problem because it has a significant impact on morbidity, mortality, length of hospital stay and overall costs [3].…”