National Collaborating Centre for Women’s and Children’s Health Surgical site infection Clinical Guideline October 2008 Funded to produce guidelines for the NHS by NICE RCOG Press 2008 RCOG Press Published by the Royal College of Obstetricians and Gynaecologists. To purchase further copies and for a complete list of RCOG Press titles, visit: www.rcogbookshop.com Surgical site infection Surgical site infection Clinical Guideline October 2008 Surgical site infection Other NICE guidelines produced by the National Collaborating Centre for Women’s and Children’s Health include: • Antenatal care: routine care for the healthy pregnant woman • Fertility: assessment and treatment for people with fertility problems • Caesarean section • Type 1 diabetes: diagnosis and management of type 1 diabetes in children and young people • Long-acting reversible contraception: the effective and appropriate use of long-acting reversible contraception • Urinary incontinence: the management of urinary incontinence in women • Heavy menstrual bleeding • Feverish illness in children: assessment and initial management in children younger than 5 years • Urinary tract infection in children: diagnosis, treatment and long-term management • Intrapartum care: care of healthy women and their babies during childbirth • Atopic eczema in children: management of atopic eczema in children from birth up to the age of 12 years • Surgical management of otitis media with effusion in children Guidelines in production include: • Diarrhoea and vomiting in children under 5 • When to suspect child maltreatment • Hypertensive disorders in pregnancy • Neonatal jaundice • Constipation in children • Bacterial meningitis and meningococcal septicaemia in children • Pregnant women with complex social factors • Autism in children and adolescents • Multiple pregnancy Enquiries regarding the above guidelines can be addressed to: National Collaborating Centre for Women’s and Children’s Health King’s Court Fourth Floor 2–16 Goodge Street London W1T 2QA enquiries@ncc-wch.org.uk A version of this guideline for patients, carers and the public is available from the NICE website (www.nice.org.uk/CG074) or from NICE publications on 0845 003 7783; quote reference number N1702. • Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period • Induction of labour prevention and treatment of surgical site infection prevention and treatment of surgical site infection [...]... the risk of surgical site infection Do not use intracavity lavage to reduce the risk of surgical site infection Antiseptic and antimicrobial agents before wound closure Do not use intraoperative skin re-disinfection or topical cefotaxime in abdominal surgery to reduce the risk of surgical site infection Wound dressings Cover surgical incisions with an appropriate interactive dressing at the end of the... the risks of surgical site infections, what is being done to reduce them and how they are managed Offer patients and carers information and advice on how to care for their wound after discharge Offer patients and carers information and advice about how to recognise a surgical site infection and who to contact if they are concerned Use an integrated care pathway for healthcare-associated infections to... Levels of evidence for intervention studies Level Source of evidence 1++ High-quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias 1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias 1− Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias 2++ High-quality systematic reviews of. .. tissue viability nurse (or another healthcare professional with tissue viability expertise) for advice on appropriate dressings for the management of surgical wounds that are healing by secondary intention Antibiotic treatment of surgical site infection and treatment failure When surgical site infection is suspected (i.e cellulitis), either de novo or because of treatment failure, give the patient an antibiotic... Additional costs attributable to SSI of between £814 and £6626 have been reported depending on the type of surgery and the severity of the infection. 4,5 The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less... the risk of surgical site infection If hair has to be removed, use electric clippers with a single-use head on the day of surgery Do not use razors for hair removal, because they increase the risk of surgical site infection Patient theatre wear Give patients specific theatre wear that is appropriate for the procedure and clinical setting and that provides easy access to the operative site and areas... as focus groups and in-depth interviews have been used in one-off projects commissioned by guideline development groups to find out more about the views and experiences of patients and carers A measure of health outcome that combines quantity and quality of life To each year of life a weight is assigned, ranging from 0 to 1, corresponding to the health-related quality of life A weight of 1 corresponds... causal 3 Non-analytical studies (for example, case reports, case series) 4 Expert opinion, formal consensus  Surgical site infection 1.7.3 Health economics The aims of the economic input to the guideline were to inform the GDG of potential economic issues relating to the prevention and treatment of SSI and its complications, and to ensure that recommendations represented cost-effective use of healthcare... risk of surgical site infection are not entirely clear Closure methods What types of closure method will reduce the risk of surgical site infection? Why this is important Although there are many studies in the field of wound closure, there are still several areas in which questions remain unanswered Natural suture materials such as catgut and silk have been replaced by tailor-made absorbable and non-absorbable... available within 2 years of the start of the review process  2 Summary of recommendations 2.1 Key priorities for implementation (key recommendations) Chapter 4  Information for patients and carers Offer patients and carers clear, consistent information and advice throughout all stages of their care This should include the risks of surgical site infections, what is being done to reduce them and how they are . of diabetes and its complications from preconception to the postnatal period • Induction of labour prevention and treatment of surgical site infection prevention and treatment of surgical site. surgical site infection