Fast Facts – Guideline for Prevention of Surgical Site Infections

Preoperative Preparation of the Patient

  • Do not remove hair preoperatively unless the hair around the incision site will interfere with the operation.
  • If hair is removed, remove immediately before the operation with electric clippers.
  • Require patients to shower or bathe with an antiseptic agent (Chlorhexidine or Dial soap which contains triclosan on at least the night before the operative day

Antimicrobial Prophylaxis

Overview: Administering pre-operative antibiotics prior to incision in certain procedures has been shown an effective intervention targeted to reduce the risk of surgical wound infection thereby enhancing patient safety.

  • Appropriately administered antibiotic prophylaxis reduces the incidence of surgical wound infection.
  • Timing of antibiotic administration is critical to efficacy.
  • First dose of antibiotic should be given before the procedure, ideally within 30 minutes but not greater than 60 minutes before incision.
  • First Antibiotic should NOT be given on the nursing unit but in the OR
  • Cefazolin is the agent of first choice for clean procedures and provides adequate coverage for many clean-contaminated procedures.
  • Prophylactic antibiotics should be discontinued within 24 hours after surgery end time

The chart below summarizes the recommendations of several prospective, randomized controlled studies as well as several systemic literature reviews addressing the use of prophylactic antibiotics in various surgical procedures.

Procedure-Specific Recommendations for Antimicrobial Prophylaxis

Procedure / Recommended Antibiotic / Adult Dose
Biliary Tract (high risk only) / Cefazolin / 1-2 grams IV
Cardiac / Cefazolin / 1-2 grams IV
Colorectal / Oral: Neomycin & Erythromycin Base

Cefotetan or Cefoxitin OR
Cefazolin
+ Metronidazole / 1 gram of each agent at 19 hours, 18 hours and 9 hours before surgery
1-2 grams IV
1-2 grams IV
0.5 grams IV
Neurosurgery
Craniotomy / Cefazolin / 1-2 grams IV
Head and Neck / Cefazolin
OR
Clindamycin and
Gentamycin / 1-2 grams IV
600-900 mg IV
1.5mg/kg IV
Hip/Knee Arthoplasty / Cefazolin / 1-2 grams IV
Gynecologic and Obstetric
Vaginal or abdominal
hysterectomy / Cefazolin

OR

Cefotetan
OR
Cefoxitin / 1-2 grams IV
1 – 2 grams IV
1 gram IV
Thoracic (Non Cardiac) / Cefazolin / 1-2 grams IV
Vascular / Cefazolin / 1-2 grams IV

* For patients allergic to penicillins or cephalosporins, Vancomycin, 1 gram intravenously two hours before incision may be used instead to provide activity against likely gram-positive organisms.

References:

  1. Center for Disease Control Guideline. Hospital Infection Control Practices Advisory Committee: Guideline for prevention of surgical site infection, 1999. Infect Control and Hosp Epidemiol 1999; 20(4): 247-78. Available online at
  2. American College of Surgeons ACS Survey. Principles and practice. WebMD Corporation, 2002.
  3. No author listed. Medical Letter - Medical Letter on Drugs and Therapeutics: Antimicrobial prophylaxis in surgery 2001; 43:92-7
  4. American Society of Health - System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. American Society of Health – System Pharmacists. Am J Health Syst Pharm 1999.Sept; 56(18): 421-68.
  5. Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WF, McGowan FE, Sweet RL, Wenzel RP. Quality standard for antimicrobial prophylaxis in surgical procedures. Release in 1994 (reviewed in 1998). Clin Infect Dis 1994 Mar; 18(3): 422-7. Infect Control Hosp Epidemiol 1994 Mar;(15): 3.
  6. Kjonniksen, I, Andersen BM, Sondenaa VG, Segadal L. Preoperative hair removal – a systemic literature review. AORN 2002. May; 75(5): 928-40.
  7. Dellinger EP. Preventing surgical site infection – the importance of timing and glucose control. Infect Cont Hosp Epidemiol 2001; 22:604-06.