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Key Points
➤ In the preoperative setting, decolonize surgical patients with an anti-
staphylococcal agent for cardiothoracic and orthopedic procedures.
• Consider decolonization for patients undergoing other procedures at high risk
of staphylococcal surgical site infection (SSI), such as those involving prosthetic
material.
➤ After a patient's incision is closed, immediately discontinue
antibiotics that were administered before and during surgery.
• No evidence supports continuing antibiotics after a patient's incision has been
closed prevents surgical site infections, even if the incision has drains.
• Continuing antibiotics increases the patient's risk of C. difficile infection, acute
kidney injury, and antimicrobial resistance.
➤ For patients undergoing elective surgery involving the colon,
administer oral antibiotics in addition to parenteral (IV) antibiotics,
rather than performing mechanical bowel preparation without oral
antibiotics.
• Patients who get mechanical bowel preparation without oral antimicrobial agents
have more complications.
➤ For patients undergoing cesarean delivery or hysterectomy, use
antiseptic-containing preoperative vaginal preparation agents to
reduce the risk of endometritis.
➤ Obtain a full allergy history.
• 10% of the population reports a penicillin allerg y, but <1% of the population is
truly allergic (CDC). Many patients with a self-reported penicillin allerg y can
safely receive the antibiotic as prophylaxis.
• Understand the nature of the patient's listed allerg y to avoid unnecessary use of less
effective antibiotics to prevent SSIs.
➤ Do not routinely use vancomycin for antimicrobial prophylaxis.
• Reserve vancomycin for specific clinical situations (e.g., if a patient is known to be
colonized with methicillin-resistant Staphylococcus aureus (MRSA), and especially
if the patient's surgery involves prosthetic material and/or will occur in the setting
of an outbreak due to MRSA).
➤ For skin preparation prior to surgical incision, data from recent trials
favor CHG-alcohol over povidone-iodine-alcohol.
➤ Perform antiseptic wound lavage intraoperatively. Ensure the sterility
of the antiseptic used.
• Evidence does not support the use of saline lavage (non-antiseptic lavage).
• The authors recommend dilute povidone-iodine lavage rather than antibiotic
irrigation.
