2016 WHO Guidelines on the Prevention of Surgical Site Infection (SSI)

by Ms. Victoria D. Villanueva

1. 2016 WHO Guidelines on the Prevention of Surgical Site Infections (SSI) Victoria D. Villanueva, RN Consultant, Chong Hua Hospital, Cebu City Former Associate Director, St Luke’s Medical Center, QC & GC Past President, Phil. Hospital Infection Control Society Past President, Phil. Hospital Infection Control Nurses Association Board Member, Asia Pacific Society of Infection Control

2. WHO adopted 29 recommendations covering 23 topics for the prevention of SSI in the pre-, intra-, and postoperative periods. Quality of evidence Very low Low Moderate High

3. 2% Chlorhexidine Gluconate Wash Cloths

4. Prophylactic Antibiotics Timing Administration of Pre-op Dose

5. Oral Antibiotic

6. Surgical Clippers

7. ≥ 0.5% Chlorhexidine Gluconate + 70% Alcohol Antimicrobial skin sealant

8. Alcohol-based Hand Rub Antimicrobial soap

9. Enhanced Nutritional Support Routes Perioperative Oxygenation

10. Warming Blanket Intravenous Fluid Therapy

11. Disposable Surgical Drapes Reusable Surgical Drapes

12. Wound Protector Device

13. Incisional Wound Irrigation

14. Prophylactic Negative Pressure Wound Therapy

15. Antimicrobial-coated Suture Laminar Flow Ventilation System

16. Advanced Dressings

17. p ublished online May 3, 2017 Recommendation Categories: Recommendations were categorized using the following standard system that reflects the level of supporting evidence or regulations : Category IA: A strong recommendation supported by high to moderate–quality evidence suggesting net clinical benefits or harms . Category IB : A strong recommendation supported by low-quality evidence suggesting net clinical benefits or harms or an accepted practice ( e.g., aseptic technique) supported by low to very low–quality evidence. Category IC : A strong recommendation required by state or federal regulation. Category II : A weak recommendation supported by any quality evidence suggesting a trade-off between clinical benefits and harms. No recommendation/unresolved issue: An issue for which there is low to very low–quality evidence with uncertain trade-offs between the benefits and harms or no published evidence on outcomes deemed critical to weighing the risks and benefits of a given intervention .

18. Recommendations: Nonparenteral Antimicrobial Prophylaxis Soaking prosthetic devices in antimicrobial solutions before implantation for the prevention of SSI. (No recommendation/ unresolved issue.) Application of autologous platelet-rich plasma is not necessary for the prevention of SSI. (Category II–weak recommendation; moderate-quality evidence suggesting a trade-off between clinical benefits and harms .) Prosthetic Joint Arthroplasty Section Blood Transfusion Do not withhold transfusion of necessary blood products from surgical patients as a means to prevent SSI. (Category IB–strong recommendation; accepted practice .) Systemic Immunosuppressive Therapy Intra-articular Corticosteroid Injection Anticoagulation

19. Recommendations: Orthopedic Surgical Space Suit Benefits and harms of orthopedic space suits or the health care personnel who should wear them for the prevention of SSI in prosthetic joint arthroplasty. (No recommendation/unresolved issue .) Postoperative Antimicrobial Prophylaxis Duration with Drain Use In prosthetic joint arthroplasty, clean and clean-contaminated procedures, do not administer additional antimicrobial prophylaxis doses after the surgical incision is closed in the operating room, even in the presence of a drain . (Category IA–strong recommendation; high-quality evidence.) Biofilm Benefits and harms regarding cement modifications and the prevention of biofilm formation or SSI in prosthetic joint arthroplasty . ( No recommendation/unresolved issue .)

20. Thank you!