Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. But surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US$ 10 billion per year.

No international evidence-based guidelines had previously been available before WHO launched its global guidelines on the prevention of surgical site infection on 3 November 2016, and there are inconsistencies in the interpretation of evidence and recommendations in existing national guidelines. These new WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

Contents

• ACKNOWLEDGEMENTS
• ABBREVIATIONS AND ACRONYMS
• GLOSSARY OF TERMS
• DECLARATION OF INTERESTS
• EXECUTIVE SUMMARY
• 1. BACKGROUND
  • 1.1. Target audience
  • 1.2. Scope of the guidelines
• 2. METHODS
  • 2.1. WHO guideline development process
  • 2.2. Evidence identification and retrieval
  • References
• 3. IMPORTANT ISSUES IN THE APPROACH TO SURGICAL SITE INFECTION PREVENTION
  • 3.1. Surgical site infection risk factors: epidemiology and burden worldwide
  • 3.2. Surgical site infection surveillance: definitions, methods and impact
  • 3.3. Importance of a clean environment in the operating room and decontamination of medical devices and surgical instruments
• 4. EVIDENCE-BASED RECOMMENDATIONS ON MEASURES FOR THE PREVENTION OF SURGICAL SITE INFECTION
  • PREOPERATIVE MEASURES
  • PREOPERATIVE AND/OR INTRAOPERATIVE MEASURES
  • POSTOPERATIVE MEASURES
• 5. DISSEMINATION AND IMPLEMENTATION OF THE GUIDELINES
  • Guidelines implementation
  • Guidelines dissemination and evaluation
• 6. ANNEXES
  • 6.1. Guidelines Development Group
  • 6.2. WHO Steering Group
  • 6.3. Systematic Reviews Expert Group
  • 6.4. External Peer Review Group
• Web appendices
  • Appendix 1. Overview of available relevant guidelines on surgical site infection prevention
  • Appendix 2. Summary of the systematic review on preoperative bathing
  • Appendix 3. Summary of the systematic review on decolonization with or without chlorhexidine gluconate body wash for the prevention of Staphylococcus aureus infection in nasal carriers undergoing surgery
  • Appendix 4. Summary of the systematic review on screening for extended-spectrum beta-lactamase colonization and the impact on surgical antibiotic prophylaxis
  • Appendix 5. Summary of a systematic review on optimal timing for preoperative surgical antibiotic prophylaxis
  • Appendix 6. Summary of the systematic review on mechanical bowel preparation and the use of oral antibiotics
  • Appendix 7. Summary of the systematic review on hair removal
  • Appendix 8. Summary of the systematic review on surgical site preparation
  • Appendix 9. Summary of the systematic review on antimicrobial skin sealants
  • Appendix 10. Summary of the systematic review on surgical hand preparation
  • Appendix 11. Summary of the systematic review on enhanced nutritional support
  • Appendix 12. Summary of the systematic review on the perioperative discontinuation of immunosuppressive agents
  • Appendix 13. Summary of the systematic review on perioperative oxygenation
  • Appendix 14. Summary of the systematic review on maintaining normal body temperature (normothermia)
  • Appendix 15. Summary of the systematic review on the use of protocols for intensive perioperative blood glucose control
  • Appendix 16. Summary of the systematic review on the maintenance of adequate circulating volume control/normovolemia
  • Appendix 17. Summary of the systematic review on drapes and gowns
  • Appendix 18. Summary of the systematic review on wound protector devices
  • Appendix 19. Summary of the systematic review on incisional wound irrigation
  • Appendix 20. Summary of the systematic review on prophylactic negative pressure wound therapy
  • Appendix 21. Summary of the systematic review on the use of surgical gloves
  • Appendix 22. Summary of the systematic review on the changing of surgical instruments
  • Appendix 23. Summary of the systematic review on antimicrobial-coated sutures
  • Appendix 24. Summary of the systematic review on laminar airflow ventilation systems in the context of operating room ventilation
  • Appendix 25. Summary of the systematic review on surgical antibiotic prophylaxis prolongation
  • Appendix 26. Summary of the systematic review on advanced dressings
  • Appendix 27. Summary of the systematic review on antimicrobial prophylaxis in the presence of a drain and optimal timing for wound drain removal

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