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Multi-drug resistant Klebsiella pneumoniaeand neutrophil. / Source: Wikimedia Commons and David Dorward; Ph.D.; National Institute of Allergy and Infectious Diseases

ACS, SIS: New Guidelines for Surgical Site Infections

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, December 12th, 2016

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While surgeons and hospitals can do extraordinary things for patients in the infection control realm, there are, say the American College of Surgeons (ACS) and the Surgical Infection Society (SIS), many things patients can do to reduce their risk of infection. The ACS and the SIS have just released guidelines for the prevention, detection, and management of surgical site infections (SSIs).

Some of the new guidelines call for a change in hospital management to reduce the risk of SSIs. While the presence of diabetes and use of diabetic medications are considered to be risk factors for SSIs, studies show that control of high blood sugar is more important immediately before an operation than over the long term. Research indicates that high blood sugar levels during an operation increase the risk of an SSI; excessively low blood sugar levels increase the risk of adverse outcomes and the frequency of hypoglycemic episodes, but they do not reduce the risk of an SSI. The consensus guidelines therefore set target blood glucose levels at 110-150 mg/dL for all patients regardless of their diabetic status in the immediate preoperative period.

Also involved in the study was principal author Therese M. Duane, M.D., M.B.A., vice-chair of quality and safety of the department of surgery and medical director of acute care surgical research, Texas Health Care, at John Peter Smith Health Network, Fort Worth.

"An important message coming out of these guidelines is that patients have a major role in their own outcomes. That message cannot be underscored enough. Smoking cessation, blood glucose control for diabetic patients, and weight loss are some of the things patients can do to prevent an SSI," Dr. Duane said.

Trying to make sure patients and their families optimize wound care after they go home is integral to the success of their treatment," added Dr. Duane.

Kristen Ban, M.D. is a general surgery resident at Loyola University Chicago, and is first author on the updated ACS/SIS guidelines. She told OTW, “We want all of our surgical colleagues to have access to one concise document that summarizes our current understanding of the best practices to reduce surgical site infections (SSI). Within the field of surgery, orthopedic surgeons have really pioneered the delivery of evidence-based care using care bundles. Our guidelines emphasize the importance of compliance with these bundles on both the patient and provider side to achieve the full benefit of these interventions. It is important for providers to know what compliance rates are with the bundles they implement, and to take action to improve compliance if it is not high.”

“One notable update that we found interesting was in regard to optimal blood glucose control. The importance of blood glucose control in the perioperative period for diabetics was previously recognized, but there is now evidence that blood glucose control in all patients, regardless of diabetic status, is associated with reduced SSI. Additionally, there is evidence that optimal blood glucose control in the perioperative period is a more important determinant of SSI risk than long-term blood glucose control for diabetics.”

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