1. Todd, Betsy MPH, RN, CIC


This updates the 1999 original, published before formal evidence-based guidelines were in routine use.


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In May, the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention released their 2017 Guideline for the Prevention of Surgical Site Infection ( This long-awaited guideline updates the 1999 original, which was published before formal evidence-based guidelines were in routine use and relied heavily on expert opinion in lieu of clinical or epidemiological studies.


The new guideline uses a modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to link the quality of evidence to the strength of its recommendations.


The 2017 guideline offers a targeted systematic review of the evidence for surgical site infection (SSI) prevention in 13 intervention categories. The authors did not reevaluate several "strong" recommendations of the 1999 guideline that are now considered to be accepted practice. These are summarized in online appendices.


Seven of the 13 intervention categories relate specifically to prosthetic joint arthroplasty, which the authors identify as procedures "in which the human and financial burden [of SSI] is greatest." There are few recommendations in this section; most of the issues raised are designated as unresolved.


Among the six interventions that apply to all types of surgeries, new category IA and IB recommendations include a perioperative blood glucose target of less than 200 mg/dL for patients with and without diabetes, a pre-op shower or bath with either an antiseptic/antimicrobial soap or plain soap, the use of an alcohol-based antiseptic skin prep, the perioperative maintenance of normothermia, and the administration of antimicrobial prophylaxis for cesarean sections before skin incision rather than after the cord is clamped.


Unresolved issues include the optimal timing and number of pre-op baths or showers, the need for additional doses of an antimicrobial agent during lengthy surgeries, the use of intraoperative antibiotic irrigation solutions, and the soaking of prosthetics in antimicrobial or antiseptic solutions prior to implant.-Betsy Todd, MPH, RN, CIC, AJN Clinical Editor