From the Guidelines
To prevent and decrease the risk of surgical site infection (SSI) after abdominal surgery, administering preoperative antibiotics within 60 minutes before incision and maintaining normothermia are crucial steps. According to the most recent and highest quality study 1, perioperative broad-spectrum intravenous antibiotics should be administered within 60 minutes before skin incision. The use of antibiotic prophylaxis before surgery has been shown to reduce surgical site infection. Additionally, maintaining normothermia (temperature >36°C) using warming devices is essential, as intraoperative normothermia decreases the rate of SSI 1.
Some key measures to prevent SSI include:
- Administering preoperative antibiotics within 60 minutes before incision
- Maintaining normothermia (temperature >36°C) using warming devices
- Using a fascial abdominal wound protector and new closure instruments after abdominal irrigation
- Changing gloves before wound closure
- Irrigating wounds with normal saline before closure, but not using antibiotic irrigation 1
- Maintaining tight glycemic control (blood glucose <180 mg/dL) for diabetic patients
- Ensuring proper hand hygiene and maintaining strict sterile technique during surgery
It is also important to note that the use of triclosan-coated suture, wound protectors, and negative-pressure wound therapy may be effective in reducing SSI, but the evidence is not as strong as for the measures mentioned above 1. Preventing preoperative hypothermia and administering antibiotics within the recommended timeframe are critical in reducing the risk of SSI, and these measures should be prioritized in clinical practice.
From the FDA Drug Label
To prevent postoperative infection in contaminated or potentially contaminated surgery, recommended doses are: 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery. The prophylactic administration of cefazolin for injection may be continued for 3 to 5 days following the completion of surgery. It is important that (1) the preoperative dose be given just (1/2 to 1 hour) prior to the start of surgery so that adequate antibiotic levels are present in the serum and tissues at the time of initial surgical incision;
The answer is a antibiotic within 1 hour before surgery, specifically 1 gram of cefazolin IV or IM administered 1/2 hour to 1 hour prior to the start of surgery 2. Preventing preoperative hypothermia is also important to decrease the risk of infection, as hypothermia can impair the immune system and increase the risk of surgical site infections. Key points to prevent and decrease the risk of Surgical Site Infection (SSI) after abdominal surgery include:
- Administering antibiotics within 1 hour before surgery
- Preventing preoperative hypothermia
- Administering additional doses of antibiotics during and after surgery as needed, based on the duration of the operative procedure and the patient's individual needs 2.
From the Research
Prevention of Surgical Site Infection (SSI) after Abdominal Surgery
To prevent and decrease the risk of SSI after abdominal surgery, several measures can be taken:
- Avoidance of hair removal from the surgical field, or using electric clippers if necessary 3
- Skin decontamination with alcoholic antiseptic 3
- Correct use of antibiotic prophylaxis, including administration within 30-60 minutes before incision, use of appropriate antibiotics, and re-dosing as needed 3, 4
- Prevention of hypothermia 3
- Control of perioperative glucose levels 3
- Avoidance of blood transfusion and restriction of intraoperative liquid infusion 3
Antibiotic Prophylaxis
The use of antibiotic prophylaxis is crucial in reducing the risk of SSI after abdominal surgery. The timing of antibiotic administration is important, with administration within 30-60 minutes before incision recommended 3, 4. The choice of antibiotic is also important, with coverage of gram-positive cocci, gram-negative bacilli, and anaerobes recommended 4.
Preventing Preoperative Hypothermia
Preventing preoperative hypothermia is also important in reducing the risk of SSI after abdominal surgery 3. This can be achieved through the use of warming devices and maintaining a warm operating room environment.
Other Measures
Other measures that can be taken to prevent SSI after abdominal surgery include:
- Using nonocclusive wound dressings and changing them as needed 5
- Avoiding the use of intra-abdominal drains unless necessary 5
- Tailoring the antibiotic prophylactic regimen to target the commonly isolated organisms in patients at higher risk for SSI 6
- Identifying and addressing potentially modifiable independent risk factors for SSI, such as open surgical approach, contaminated wound class, and emergency surgery 6