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Guideline for Prevention of Surgical Site Infection, 1999

Executive Summary

I. Surgical Site Infection (Ssi): An Overview

  1. Introduction
  2. Key Terms Used in the Guideline
    1. Criteria for defining SSIs
    2. Operating suite
    3. Operating room
    4. Surgical personnel
    5. Surgical team member
  3. Microbiology
  4. Pathogenesis
  5. Risk and Prevention
    1. Patient characteristics
      1. Diabetes
      2. Nicotine use
      3. Steroid use
      4. Malnutrition
      5. Prolonged preoperative hospital stay
      6. Preoperative nares colonization with Staphylococcus aureus
      7. Perioperative transfusion
    2. Operative characteristics: Preoperative issues
      1. Preoperative antiseptic showering
      2. Preoperative hair removal
      3. Patient skin preparation in the operating room
      4. Preoperative hand/forearm antisepsis
      5. Management of infected or colonized surgical personnel
      6. Antimicrobial prophylaxis
    3. Operative characteristics: Intraoperative issues
      1. Operating room environment
      2. Surgical attire and drapes
      3. Asepsis and surgical technique
    4. Operative characteristics: Postoperative issues
      1. Incision care
      2. Discharge planning
  6. SSI Surveillance
    1. SSI risk stratification
      1. Concepts
      2. Issues
    2. SSI surveillance methods
      1. Inpatient SSI surveillance
      2. Postdischarge SSI surveillance
      3. Outpatient SSI surveillance
  7. Guideline Evaluation Process

II. Recommendations For Prevention Of Surgical Site Infection

  1. Rationale
  2. Rankings
  3. Recommendations
    1. Preoperative
      1. Preparation of the patient
      2. Hand/forearm antisepsis for surgical team members
      3. Management of infected or colonized surgical personnel
      4. Antimicrobial prophylaxis
    2. Intraoperative
      1. Ventilation
      2. Cleaning and disinfection of environmental surfaces
      3. Microbiologic sampling
      4. Sterilization of surgical instruments
      5. Surgical attire and drapes
      6. Asepsis and surgical technique
    3. Postoperative incision care
    4. Surveillance

References

Selected Readings

Figure

Table 1. Criteria for Defining a Surgical Site Infection (SSI)

Table 2. Site-Specific Classifications of Organ/Space Surgical Site Infection

Table 3. Distribution of Pathogens Isolated From Surgical Site Infections, National Nosocomial Infections Surveillance System, 1986 to 1996

Table 4. Operations, Likely Surgical Site Infection (SSI) Pathogens, and References on Use of Antimicrobial Prophylaxis

Table 5. Patient and Operation Characteristics That May Influence the Risk of Surgical Site Infection Development

Table 6. Mechanism and Spectrum of Activity of Antiseptic Agents Commonly Used for Preoperative Skin Preparation and Surgical Scrubs

Table 7. Surgical Wound Classification

Table 8. Parameters for Operating Room Ventilation, American Institute of Architects, 1996

Table 9. Parameters for Flash Sterilization Cycles, Association for the Advancement of Medical Instrumentation

Table 10. Physical Status Classification, American Society of Anesthesiologists

 
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