SHEA: New SSI guidance recommends antibiotics be discontinued after incision is closed

Editor's Note

This update to the 2014 "Strategies to Prevent Surgical Site Infections in Acute Care Hospitals" recommends that antibiotics be discontinued after a patient’s incision has been closed in the OR, even if drains are present.

The expert panel members writing the update add that continuing antibiotics after closure increases the patient’s risk of Clostridioides difficile infection, antimicrobial resistance, and acute kidney injury.

Among other recommendations in the update are:

• Obtaining a full allergy history from patients who report penicillin allergy
• Decolonizing patients undergoing high-risk procedures with an anti-staphylococcal agent preoperatively
• Monitoring patients with elevated blood-glucose levels regardless of diabetes status
• Using antimicrobial prophylaxis before elective colorectal surgery
• Consider using negative-pressure dressings, especially after abdominal and joint arthroplasty procedures.

Additional topics include risk factors for SSIs, surveillance methods, infrastructure requirements, antiseptic wound lavage, and sterile reprocessing.

The new guidance was sponsored by the Society for Healthcare Epidemiology of America (SHEA) in collaboration with the Infectious Diseases Society of America (IDSA), Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, and others.