The Centers for Disease Control and Prevention (CDC) recently updated its "Guideline for the Prevention of Surgical Site Infection (SSI)." The 2017 version of the guideline, published in the JAMA Surgery journal, updates the last version, released in 1999. Where in the past recommendations were based on what the CDC described as "expert opinion," it is now commonplace to base clinical guidelines on evidence-based grading.
To develop the new guideline, CDC set out to determine if there was evidence-based support for the 42 statements included in the old version. Following a substantial literature review of more than 5,000 pieces published from 1998 through April 2014, CDC made recommendations on just 17 of those statements.
Despite this outcome, the new guideline still includes important information for ambulatory surgery centers. Here are four of the key takeaways.
- Most applicable recommendations. The recommendations most likely to affect ASCs are the following:
- Patients should shower or bathe with soap or an antiseptic agent at least one night before the operative day.
- Normothermia should be maintained in all patients.
- Skin preparation in the operating room should be performed using an alcohol-based agent (unless contraindicated).
- During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL.
- For clean and clean-contaminated procedures, do not give additional prophylactic antimicrobial doses after closing the surgical incision, even if the patient has a drain in place.
- Do not apply topical antimicrobial agents to the incision.
- Strengthening of existing processes. Generally, ASCs already following these recommendations, but their inclusion in the new guideline gives more "weight" to their importance. When ASCs tell patients about the need to bathe prior to a procedure or if a medical advisory committee (MAC) is considering the development of a policy that includes these recommendations, there is now a federal guideline that follows evidence-based evaluations to reference as support for the practices.
- Powerful tool to change practices. In the event that any of an ASC’s physicians are not already following these recommendations; the publishing of the new guideline can serve as a mechanism to standardize care. An ASC's MAC should share the guideline with these physicians and iterate the importance of following the federal guideline.
- Legal basis for change. In the event of a litigious situation, authorities consider federal guidelines, such as those from the CDC and National Institutes of Health, as the "standard of practice" upon which they, in part, measure compliance. The potential legal risk of failing to follow federal recommendations can help persuade even the most stubborn of physicians to update their practices.