A comparison of Surgical Infection Society (SIS) vs Internationals surgical site infection (SSI) prevention Guidelines.

Radwan Dipp Ramos; June Kim; Andrew Stephen; Matthew Swenson; Daithi Heffernan

Surgical Site Infections (SSIs) are a significant cause of morbidity and mortality. Adherence to guidelines have been shown to decrease the incidence of SSIs. However, guidelines are often developed to be region, country or resource specific or can be heavily influenced by locoregional politics.

We used the SIS (Surgical Infection Society) guidelines as reference. The literature was reviewed for International non-SIS Guidelines (IGs). Individual component recommendations were divided into pre-operative, intra-operative and post-operative categories. The IGs were reviewed to identify whether they matched or were different from SIS prevention guidelines.

We reviewed 11 IGs aimed at prevention of SSIs. Pre-operative bath recommendations appeared in 81.8% of IGs. There was considerable variation between timing and techniques for bathing. Glucose control was recommended among 72.7% of IGs. Only 19.2% of IGs recommend smoking cessation. Among intra-operative recommendations, 100% of all identified IGs recommended prophylactic antibiotics, however several IGs left of the choice of antimicrobial agent to the discretion of the surgeon. Further timing of administration of prophylactic antibiotics varied from 1 to 6 hours pre-operatively. Skin preparation, hand scrub, and normothermia were identified in 91%, 81%, and 72% of IGs respectively. Surprisingly, the use of double gloves and wound protector only were recommended in 54.5% and 36.3%. From the post-op recommendation wound, care was recommend in 63.4%. IG recommendations not mentioned in SIS /ACS guidelines included improvement of pre-operative nutritional status (36.3%) and alcohol cessation (9%). Among the intra-operative recommendation normovolemia was recommend in 36.3% of IGs and irrigation of the wound before closure was recommend in 27.3%.

Considerable international variation exists with respect to SSI prophylaxis guidelines. However, the literature on which guidelines are based is often difficult or expensive to access in low-income countries. We advocate that critical guidelines and their underlying literature should be freely available to improve world-wide peri-operative care.