Prevention of infections following surgical procedures is a major focus of work across VUMC. Prevention involves use of core evidenced-based practices designed to reduce a patient's risk, and includes practices such as antibiotic prophylaxis, skin preparation, maintaining patient normothermia, preventing hyperglycemia (even in patients without a diagnosis of diabetes mellitus). Some key articles on some of these core practices are highlighted below.
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Guidelines:
Timing:
- TRAPE Study (2009) Steinberg JP et al
- Classen DC et al NEJM 1992
- Weber et al 2008 Ann Surgery - Cefazolin given 59-30min pre-incision better than if given <30mins prior
Redosing:
Duration:
- McDonald M et al (1998) Aust N Z Surg - Meta-analysis supporting single dose vs. multiple dose for prophylaxis
- Branch-Elliman W et al (2019) JAMA Surg - Multicenter national cohort study showing increased antimicrobial-associated adverse events with prophylaxis >24 hours
Impact of Penicillin Allergy:
- Blumenthal KG et al (2018) Clin Infect Dis - Patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of second-
line perioperative antibiotics. - Seidelman JL et al (2022) Infect Control Hosp Epidemiol
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- Kurz, A., Sessler, D. I., & Lenhardt, R. (1996). Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. The New England journal of medicine, 334(19), 1209–1215. https://doi.org/10.1056/NEJM199605093341901
- Madrid, E., Urrútia, G., Roqué i Figuls, M., Pardo-Hernandez, H., Campos, J. M., Paniagua, P., Maestre, L., & Alonso-Coello, P. (2016). Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. The Cochrane database of systematic reviews, 4(4), CD009016. https://doi.org/10.1002/14651858.CD009016.pub2
- Insler, S. R., & Sessler, D. I. (2006). Perioperative thermoregulation and temperature monitoring. Anesthesiology clinics, 24(4), 823–837. https://doi.org/10.1016/j.atc.2006.09.001
- National Collaborating Centre for Nursing and Supportive Care (UK). (2008). The Management of Inadvertent Perioperative Hypothermia in Adults. Royal College of Nursing (UK).
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- Duggan, E. W., Carlson, K., & Umpierrez, G. E. (2017). Perioperative Hyperglycemia Management: An Update. Anesthesiology, 126(3), 547–560. https://doi.org/10.1097/ALN.0000000000001515
- Joshi, G. P., Chung, F., Vann, M. A., Ahmad, S., Gan, T. J., Goulson, D. T., Merrill, D. G., Twersky, R., & Society for Ambulatory Anesthesia (2010). Society for Ambulatory Anesthesia consensus statement on perioperative blood glucose management in diabetic patients undergoing ambulatory surgery. Anesthesia and analgesia, 111(6), 1378–1387. https://doi.org/10.1213/ANE.0b013e3181f9c288
- Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., Seley, J. J., Van den Berghe, G., & Endocrine Society (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. The Journal of clinical endocrinology and metabolism, 97(1), 16–38. https://doi.org/10.1210/jc.2011-2098
- Ehrenfeld, J. M., Wanderer, J. P., Terekhov, M., Rothman, B. S., & Sandberg, W. S. (2017). A Perioperative Systems Design to Improve Intraoperative Glucose Monitoring Is Associated with a Reduction in Surgical Site Infections in a Diabetic Patient Population. Anesthesiology, 126(3), 431–440. https://doi.org/10.1097/ALN.0000000000001516
- Akhtar, S., Barash, P. G., & Inzucchi, S. E. (2010). Scientific principles and clinical implications of perioperative glucose regulation and control. Anesthesia and analgesia, 110(2), 478–497. https://doi.org/10.1213/ANE.0b013e3181c6be63
- Bellusse, G. C., Ribeiro, J. C., de Freitas, I. C. M., & Galvão, C. M. (2020). Effect of perioperative hyperglycemia on surgical site infection in abdominal surgery: A prospective cohort study. American journal of infection control, 48(7), 781–785. https://doi.org/10.1016/j.ajic.2019.11.009
- Kotagal, M., Symons, R. G., Hirsch, I. B., Umpierrez, G. E., Dellinger, E. P., Farrokhi, E. T., Flum, D. R., & SCOAP-CERTAIN Collaborative (2015). Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Annals of surgery, 261(1), 97–103. https://doi.org/10.1097/SLA.0000000000000688
- Kwon, S., Thompson, R., Dellinger, P., Yanez, D., Farrohki, E., & Flum, D. (2013). Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Annals of surgery, 257(1), 8–14. https://doi.org/10.1097/SLA.0b013e31827b6bbc
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VUMC has developed several standard evidenced-based bundles to prevent SSIs.
These can be found at https://www.vumc.org/infection-prevention/vumc-infection-prevention-guidelines