2016-11 WHO – GLOBAL GUIDELINES FOR THE PREVENTION OF SURGICAL SITE INFECTION 186 pags.

November 7, 2016 at 8:44 am

 

CONTENTS

Acknowledgements …………………..………………………. 6

Abbreviations and acronyms ………………………..……. 8

Glossary …………………………………..……………….…..…. 9

Declaration of interests …………..……………………….. 12

Executive summary………………….………………………. 13

Summary of core topics, research questions and recommendations for the prevention of surgical site infection …………. 15

  1. Background…………………………………………….. .21

1.1 Target audience …………………………………………. ..22

1.2 Scope of the guidelines ……………………………… …22

  1. Methods …………………………………………………. .23

2.1 WHO guideline development process…………. ….23

2.2 Evidence identification and retrieval………….. …24

  1. Important issues in the approach to surgical site infection prevention ……………………………………………….27

3.1 Surgical site infection risk factors: epidemiology and burden worldwide ………………………………………………………..27

3.2 Surgical site infection surveillance: definitions and methods and impact ………………………………………………………………38

3.3 Importance of a clean environment in the operating room and decontamination of medical devices and surgical instruments……………………………………………………….. 45

3.3.1 Environment……………………………………………… 45

3.3.2 Decontamination of medical devices and surgical instruments……………………………………………………….. 47

  1. Evidence-based recommendations on measures for the prevention of surgical site infection …………….. 58

Preoperative measures

4.1 Preoperative bathing …………………………………….. 58

4.2 Decolonization with mupirocin ointment with or without chlorhexidine gluconate body wash for the prevention of Staphylococcus aureus infection in nasal carriers undergoing surgery………………………………………………………………. 63

4.3 Screening for extended-spectrum beta-lactamase colonization and the impact on surgical antibiotic prophylaxis…………………………………………………………. 69

4.4 Optimal timing for preoperative surgical antibiotic prophylaxis …………………………………………………………………………… 71

4.5 Mechanical bowel preparation and the use of oral antibiotics ……………………………………………………………………………76

4.6 Hair removal…………………………………………………. 82

4.7 Surgical site preparation…………………………………. 87

4.8 Antimicrobial skin sealants …………………………….. 92

4.9 Surgical hand preparation……………………………….. 95

Preoperative and/or intraoperative measures

4.10 Enhanced nutritional support……………………….. 102

4.11 Perioperative discontinuation of immunosuppressive agents………………………………………………………………… 107

4.12 Perioperative oxygenation…………………………….. 110

4.13 Maintaining normal body temperature (normothermia)………………………………………………….. 116

4.14 Use of protocols for intensive perioperative blood glucose control ……………………………………………………………….. 120

4.15 Maintenance of adequate circulating volume control/normovolemia …………………………………………. 126

4.16 Drapes and gowns …………………………………………. 131

4.17 Wound protector devices ……………………………….. 136

4.18 Incisional wound irrigation ……………………………. 140

4.19 Prophylactic negative pressure wound therapy…. 145

4.20 Use of surgical gloves…………………………………….. 149

4.21 Changing of surgical instruments……………………. 152

4.22 Antimicrobial-coated sutures…………………………. 153

4.23 Laminar airflow ventilation systems in the context of operating room ventilation …………………………………………………… 158

Postoperative measures

4.24 Surgical antibiotic prophylaxis prolongation ……. 163

4.25 Advanced dressings ………………………………………… 171

4.26 Antibiotic prophylaxis in the presence of a drain and optimal timing for wound drain removal………………………………. 174

  1. Dissemination and implementation of the guidelines………………………………………………………. 178
  2. Annexes…………………………………………………………. 180

6.1 Guidelines Development Group …………………………. .180

6.2 WHO Steering Group ……….………………………….…… .182

6.3 Systematic Reviews Expert Group ………………………. 182

6.4 External Peer Review Group ………..……………………… 184

 

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 the 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

 

PDF

http://www.who.int/gpsc/global-guidelines-web.pdf

 

Entry filed under: Antimicrobianos, Bacterias, CONSENSOS, Desinfection and Sterilization, Epidemiología, GUIDELINES, Health Care-Associated Infections, Infecciones nosocomiales, Infecciones sitio quirurgico, Profilaxis Antibiótica en Cirugía - PAC, REVIEWS, Update. Tags: .

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