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 recent guidelines and studies, including those published in 2023 1. The use of prophylactic antibiotics, such as first-generation cephalosporins like cefazolin, has been shown to reduce SSI rates 1. Additionally, maintaining normothermia during surgery, defined as a core temperature greater than 36°C, is crucial in reducing the risk of SSI 1.
Some key measures to prevent SSI include:
- Administering prophylactic antibiotics within 60 minutes before skin incision, with some agents requiring administration over 1-2 hours 1
- Using a fascial abdominal wound protector and new closure instruments after abdominal irrigation, as well as a glove change, to reduce SSI rates 1
- Maintaining normothermia during surgery using warming devices 1
- Controlling blood glucose levels and optimizing tissue oxygenation to reduce the risk of SSI 1
- Irrigating wounds with normal saline before closure, but avoiding antibiotic irrigation 1
It is essential to note that the use of triclosan-coated suture, wound protectors, and negative-pressure wound therapy may also be effective in reducing SSI rates, as suggested by a 2020 study 1. However, the most recent and highest-quality evidence prioritizes the administration of prophylactic antibiotics and maintenance of normothermia as key measures to prevent SSI 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
Preventing Surgical Site Infections (SSIs) after Abdominal Surgery
To prevent and decrease the risk of Surgical Site Infections (SSIs) after abdominal surgery, several measures can be taken:
- Administering antibiotics within a certain timeframe before the surgery is crucial. According to 3, appropriate antibiotic selection and timing of administration for prophylaxis are crucial to reduce the likelihood of SSI after elective colorectal surgery with intestinal anastomosis.
- Preventing preoperative hypothermia is also important, although the provided studies do not directly address this topic in relation to SSI prevention after abdominal surgery.
- Other strategies include:
- Smoking cessation and nutritional screening, as mentioned in 4, although these are not directly related to the timing of antibiotic administration or prevention of preoperative hypothermia.
- Proper wound care and dressing, as discussed in 4, which highlights the importance of nonocclusive wound dressings and proper hand disinfection before manipulating dressings.
- Avoiding unnecessary intra-abdominal drains, as noted in 4, which mentions that about 43% of surgeons use intra-abdominal drains after colon surgery.
Timing of Antibiotic Administration
The timing of antibiotic administration is critical in preventing SSIs:
- 3 suggests that the initial dose of antibiotics should be administered within 30 minutes prior to incision.
- 5 found that for patients undergoing emergency appendectomies who have received broad-spectrum antibiotic treatment, additional pre-incisional cefazolin does not reduce the incidence of superficial/deep or organ-space SSI.
Risk Factors for SSIs
Several risk factors for SSIs have been identified:
- Open surgical approach, emergency operation, long operation duration, and male sex are independent predictors of SSI, as noted in 6.
- The type of antibiotic prophylaxis used can also impact the risk of SSI, with 7 suggesting that vancomycin/gentamicin may be as effective as cephalosporins in preventing SSIs after cardiac surgery.