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, administering perioperative broad-spectrum intravenous antibiotics within 60 minutes before skin incision and maintaining normothermia are crucial steps. According to the most recent and highest quality study 1, perioperative antibiotics should be administered within 60 minutes before skin incision, and continuation of antibiotics should be decided according to the pathology and contamination found during surgery.

Some key measures to prevent SSI include:

• Administering preoperative antibiotics within 60 minutes before incision, as recommended by 1
• Maintaining normothermia (core temperature >36°C) using warming devices, as suggested by 1 and 1
• Practicing meticulous surgical technique with proper hand hygiene and sterile technique
• Using a fascial abdominal wound protector and new closure instruments after abdominal irrigation, as recommended by 1
• Changing gloves before wound closure, as found to reduce surgical site infection by 13% in a recent large cluster randomized trial 1

It is also important to note that:

• The use of triclosan-coated suture significantly reduces SSI prevalence compared with non-coated sutures, as found in 1
• Wound protectors, especially dual-ring constructed wound protectors, have protective effects in reducing incisional SSI, as suggested by 1
• Negative-pressure wound therapy may be effective in reducing postoperative wound complications, especially in patients with a high risk of infection, as mentioned in 1

In terms of specific antibiotic administration, administering antibiotics within 12 hours is not the most accurate recommendation, as the most recent study 1 suggests administration within 60 minutes before skin incision. Additionally, preventing preoperative hypothermia is crucial, as intraoperative normothermia decreases the rate of SSI, as found in 1.

Overall, a comprehensive approach including preoperative, intraoperative, and postoperative measures is necessary to prevent and decrease the risk of SSI after abdominal surgery, with a focus on administering perioperative antibiotics and maintaining normothermia.

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.