The first ever Global guidelines for the prevention of surgical site infection (SSI) were published on 3 November 2016, then updated in some parts and published in a new edition in December 2018. They include a list of 29 concrete recommendations on 23 topics for the prevention of SSI in the pre-, intra and postoperative periods, which are based on 28 systematic reviews of the evidence.

For the 2018 update, the membership of the guidelines development group (GDG) was broadened to include an additional eight anaesthesiology experts. The 2018 edition of the guidelines includes the revision of the recommendation regarding the use of 80% fraction of inspired oxygen (high FiO2) in surgical patients under general anaesthesia with tracheal intubation and the update of the section on implementation. Between 2017 and 2018, WHO re-assessed the evidence on the use of high FiO2 by updating the systematic review related to the effectiveness of this intervention to reduce SSI and commissioning an independent systematic review on adverse events potentially associated with it. Based on the updated evidence, the GDG decided to revise the strength of the recommendation from strong to conditional.

Contents

• Acknowledgements
• Abbreviations and Acronyms
• Glossary of Terms
• Declaration of Interests
• Executive Summary
• 1. Background
  • 1.1. Target audience
  • 1.2. Scope of the guidelines
• 2. Methods
  • 2.1. WHO guideline development process
  • 2.2. Evidence identification and retrieval
  • References
• 3. Important Issues in the Approach to Surgical Site Infection Prevention
  • 3.1. Surgical site infection risk factors: epidemiology and burden worldwide
  • 3.2. Surgical site infection surveillance: definitions, methods and impact
  • 3.3. Importance of a clean environment in the operating room and decontamination of medical devices and surgical instruments
• 4. Evidence-Based Recommendations on Measures for the Prevention of Surgical Site Infection
  • Preoperative Measures
  • Preoperative and/or Intraoperative Measures
  • Postoperative Measures
• 5. Dissemination and Implementation of the Guidelines
  • Guidelines implementation
  • Guidelines dissemination and evaluation
  • References
• 6. Annexes
  • 6.1. Guidelines Development Group
  • 6.2. WHO Steering Group
  • 6.3. Systematic Reviews Expert Group
  • 6.4. External Peer Review Group
• Web appendices
  • Web Appendix 1. Overview of available relevant guidelines on surgical site infection prevention
  • Web Appendix 2. Summary of a systematic review on preoperative bathing
  • Web Appendix 3. Summary of a systematic review on decolonization with mupirocin ointment with or without chlorhexidine gluconate body wash for the prevention of Staphylococcus aureus infection in nasal carriers undergoing surgery
  • Web Appendix 4. Summary of a systematic review on screening for extended spectrum beta-lactamase and the impact on surgical antibiotic prophylaxis
  • Web Appendix 5. Summary of a systematic review on optimal timing for preoperative surgical antibiotic prophylaxis
  • Web Appendix 6. Summary of a systematic review on mechanical bowel preparation and the use of oral antibiotics
  • Web Appendix 7. Summary of a systematic review on the effectiveness and optimal method of hair removal
  • Web Appendix 8. Summary of a systematic literature review on surgical site preparation
  • Web Appendix 9. Summary of a systematic review on antimicrobial skin sealants
  • Web Appendix 10. Summary of a systematic review on surgical hand preparation
  • Web Appendix 11. Summary of a systematic review on enhanced nutritional support
  • Web Appendix 12. Summary of a systematic review on the perioperative discontinuation of immunosuppressive agents
  • Web Appendix 13a. Summary of the systematic review on perioperative oxygenation issued in 2016. Superseded by Appendix 13b and 13c
  • Web Appendix 13b. Effectiveness of 80% versus 30–35% fraction of inspired oxygen in patients undergoing surgery: an updated systematic review and meta-analysis
  • Web Appendix 13c. Safety of 80% vs 30–35% fraction of inspired oxygen in patients undergoing surgery: a systematic review and meta-analysis
  • Web Appendix 14. Summary of a systematic review on maintaining normal body temperature (normothermia)
  • Web Appendix 15. Meta-analysis of lower perioperative blood glucose target levels for reduction of surgical-site infection
  • Web Appendix 16. Summary of a systematic review on the maintenance of adequate circulating volume control/normovolemia
  • Web Appendix 17. Summary of a systematic review on drapes and gowns
  • Web Appendix 18. Summary of a systematic review on wound protector devices
  • Web Appendix 19. Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections
  • Web Appendix 20. A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery
  • Web Appendix 21. Summary of a systematic review on the use of surgical gloves
  • Web Appendix 22. Summary of a systematic review on the changing of surgical instruments
  • Web Appendix 23. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis
  • Web Appendix 24. Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis
  • Web Appendix 25. Summary of a systematic review on surgical antibiotic prophylaxis prolongation
  • Web Appendix 26. Summary of a systematic review on advanced dressings
  • Web Appendix 27. Summary of a systematic review on antimicrobial prophylaxis in the presence of a drain and wound drain removal

Suggested citation:

Global guidelines for the prevention of surgical site infection, second edition. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

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