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WHOGuidelines:29WaystoPreventSurgicalSiteInfections
MeganBrooks November03,2016
Newguidanceonpreventingsurgicalsiteinfections(SSIs)fromtheWorldHealthOrganization(WHO)recommendthat
patientsbatheorshowerbeforesurgerybutthattheynotbeshaved,andthatantibioticsbeusedimmediatelybeforeand
duringsurgerybutnotafterward.

TheGlobalGuidelinesforthePreventionofSurgicalSiteInfectionweredevelopedbyapanelofexpertswhoreviewedthe
latestevidenceonpreventingSSIs.Theyinclude29concreterecommendationstobeappliedinthepre,intra,and
postoperativeperiods.

Theguidelinesarevalidforanycountryandaresuitableforlocaladaptation.Theytakeintoaccountthestrengthofavailable
scientificevidence,costandresourceimplications,andpatientvaluesandpreferences,theWHOsays.Theguidelines
complementtheWHOSurgicalSafetyChecklistbyprovidingmoredetailedrecommendationsonSSIprevention,theagency
says.

Thenewguidelines,ifimplemented,willsavelives,reduceharm,cutcosts,andlimitthespreadofantibioticresistance,the
WHOpredicts.

HugeBurden,HighlyPreventable

SSIisanissuethat"concernseveryone,"EdKelley,PhD,WHOdirectorofservicedeliveryandsafety,saidduringapress
briefing."Therearenoreliableestimatesorglobaldatabaseorregistrytrackingexactlythenumberofsurgicalsiteinfections
thatoccureveryyear,butWHOestimatesthatmillionsofpatientsareaffectedbysurgicalsiteinfectionsannually,"headded.

SSIis"highlypreventable,"DrKelleysaid,andthenewWHOguidelinesare"themostextensivesetofglobalguidelinesever
producedonthissubject."

Untilnow,nointernationalevidencebasedguidelineshadbeenpublished,andthereareinconsistenciesintheinterpretationof
evidenceandrecommendationsregardingexistingnationalguidelines,theWHOnotes.

TheguidelineswerepublishedonlineNovember2intwoseparatearticlesintheLancetInfectiousDiseases.

Theguidelinessayitis"goodclinicalpractice"forpatientstobatheorshowerbeforesurgery,andtheyrecommendeitherplain
soaporanantimicrobialsoap.

Withregardtothetimingoftheuseantibiotics,thereisevidencethatantibioticsgivenbeforesurgerycanpreventinfectionsfor
certainsurgicalprocedures,butthereisnoevidencethatuseofantibioticsaftersurgerypreventsinfections,theguidelinessay.

Therecommendationistoadministersurgicalantibioticprophylaxiswithin120minutesbeforeincisionandthatconsideration
begiventothehalflifeoftheantibiotic."Obviously,theselectionoftheantibiotics,theexactappropriatenessoftheantibiotic
foragivenpatientisuptotheclinician,"DrKelleynoted.

NoShaving

Theguidelines"strongly"discourageshavingatalltimes,whetherpreoperativelyorintheoperatingroom.Theguidelinessay
thathairshouldeithernotberemovedor,ifabsolutelynecessary,beremovedonlywithaclipper.

Shavingissomethingthathas"longbeenassumedwasnecessarytofacilitateskinexposure,"DrKelleysaid.However,after
extensivereviewoftheevidenceandlengthydiscussion,theexpertpanelconcludedthat"hairremovalcanactuallyincrease
theriskofcausingmicroscopiccutsortraumastotheskin,andtheevidencetellsusthereisclearbenefittonotremovingthe
hairorsimplyclippingitifitabsolutelyneedstobedone,"DrKelleysaid.

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Theguidelinesalsospelloutthebestwayforsurgicalteamstocleantheirhands,whatdisinfectantstousebeforeincision,
whichsuturestouse,andthebestapproachtotheuseofdrapesandgownsforpreventingSSIs.

Althoughtheguidelinesareintendedforsurgicalpatientsofallages,somerecommendationsdonotapplytothepediatric
population,owingtolackofevidenceorinapplicability.Thisisclearlystatedintheguidelines.

"Nooneshouldgetsickwhileseekingorreceivingcare,"MariePauleKieny,PhD,WHOassistantdirectorgeneralforhealth
systemsandinnovation,saidinanewsrelease."Preventingsurgicalinfectionshasneverbeenmoreimportant,butitis
complexandrequiresarangeofpreventivemeasures.Theseguidelinesareaninvaluabletoolforprotectingpatients."

"Ireallywelcomeonbehalfofdoctorsthissetofguidelines,"DameSallyDavies,MD,chiefmedicalofficer,UnitedKingdom,
toldreportersatthebriefing."It'sWHOatitsbestevidencebased,normativeguidelinesthatarestraightforwardandsimple
touse.Weallknowthatwe'vegottouseourresourcescarefully,andyoutelluswhentousethemandwhennottousethem
inthis,andthat'sterriblyimportant,"sheadded.

TheWHO'snextstepwillbetoworkwithcountriesandexpertstoprepareanimplementationguideandassessmenttoolkit,Dr
Kelleysaid.

LancetInfectDis.PublishedonlineNovember2,3016.Preoperativerecommendations,AbstractIntraandpostoperative
recommendations,Abstract

MedscapeMedicalNews2016WebMD,LLC

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