How to prevent and decrease the risk of Surgical Site Infection (SSI) after abdominal surgery?

From the Guidelines

To prevent and decrease the risk of Surgical Site Infection (SSI) after abdominal surgery, administer prophylactic antibiotics within 60 minutes before skin incision and maintain normothermia during surgery. This approach is supported by the most recent and highest quality study, which emphasizes the importance of perioperative broad-spectrum intravenous antibiotics and normothermia in reducing SSI risk 1.

Preoperative Measures

Before surgery, ensure proper patient optimization by:

• Controlling blood glucose levels (maintaining below 180 mg/dL)
• Encouraging smoking cessation at least 4 weeks prior to surgery
• Treating any remote infections
• Administering appropriate prophylactic antibiotics 30-60 minutes before incision, such as cefazolin 2g IV (3g for patients >120kg) for clean procedures or cefazolin plus metronidazole 500mg IV for procedures involving the bowel
• Performing proper skin preparation using chlorhexidine-alcohol solution rather than povidone-iodine
• Ensuring hair removal is done with clippers rather than razors if necessary

Intraoperative Measures

During surgery:

• Maintain normothermia (core temperature >36°C) to decrease the rate of SSI, as recommended by 1
• Ensure good tissue oxygenation
• Practice meticulous surgical technique with proper hemostasis
• Minimize operative time and handle tissues gently
• Use a fascial abdominal wound protector and new closure instruments after abdominal irrigation, as well as a glove change, to reduce SSI risk 1
• Consider using triclosan-coated suture and wound protectors, such as dual-ring constructed wound protectors, to reduce SSI prevalence 1

Postoperative Measures

Postoperatively:

• Maintain strict wound care with sterile technique when changing dressings
• Continue glucose control
• Remove urinary catheters and other invasive devices as soon as clinically appropriate
• Promote early ambulation and nutritional support to enhance wound healing and reduce infection risk
• Consider applying negative-pressure wound therapy to prevent SSI, especially in patients with a high risk of infection 1

From the FDA Drug Label

The prophylactic administration of Cefazolin for Injection, USP preoperatively, intraoperatively, and postoperatively may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures which are classified as contaminated or potentially contaminated (e.g., vaginal hysterectomy and cholecystectomy in high-risk patients such as those older than 70 years, with acute cholecystitis, obstructive jaundice, or common duct bile stones). 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.

To prevent and decrease the risk of Surgical Site Infection (SSI) after abdominal surgery, the following measures can be taken:

• Administering an antibiotic such as cefazolin within 1 hour before the start of surgery, as recommended in the drug label 2.
• Preventing preoperative hypothermia is also important, although the exact details are not provided in the given drug labels. It is essential to note that the administration of antibiotics should be done according to the recommended dosage and timing to ensure effectiveness and minimize the risk of antibiotic resistance. The dosage and administration guidelines for cefazolin are provided in the drug label 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