Quality & Patient Safety

CDC updates SSI guideline for the first time in 18 years

Patient Safety Monitor, June 21, 2017

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In May 2017, the CDC released its new guideline for surgical site infection (SSI) prevention, the first such update since the turn of the century.

Between 2006 and 2009, roughly 1.9% of surgical procedures in the United States resulted in SSI complications; however, it’s likely that number is much higher since about 50% of SSIs don’t become evident until after discharge. Estimated costs of SSIs range from $10,443 to $25,546 per infection, although it can cost more than $90,000 to treat an SSI involving a prosthetic joint implant or an antimicrobial-resistant organism.    

“There is increasing demand for evidence-based interventions for the prevention of SSI,” wrote lead author Sandra Berríos-Torres, MD, in the guideline. “The last version of the CDC Guideline for Prevention of Surgical Site Infection was published in 1999. While the guideline was evidence informed, most recommendations were based on expert opinion, in the era before evidence-based guideline methods.”

Answering the call of healthcare professionals, the CDC updated the guideline using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process to condense thousands of studies into 170 high-quality trials. The results were then categorized by the strength of the evidence supporting them.

The news was published in JAMA Surgery and includes an accompanying editorial.
“The [updated] CDC guidelines use a strict process for literature review, development of consensus, public reporting, and refinement of their final recommendations,” wrote Pamela A. Lipsett, MD, MHPE, MCCM, in the accompanying editorial. “The article from the CDC by Berríos-Torres et al in this issue of JAMA Surgery is useful to every surgeon because it is brief and summarizes the recommendations, with their level of support. It tells us what we should do and what we do not know. The supplementary material is inclusive and recommended for anyone with a thirst for the evidence supporting these recommendations.”

Peggy Prinz Luebbert, MS, CIC, CHSP, CSPT, an infection prevention and healthcare safety professional and consultant, says that having guidance based on expert opinion rather than evidence is par for the course in our society right now. It’s difficult and expensive to scientifically validate medical recommendations, which unfortunately means physicians often have to depend on opinions. That’s what makes the CDC’s update such a breath of fresh air.

“I’d say it’s easier for us to present information to our surgeons when the science is there and has been validated,” she says. “Unfortunately, that’s so difficult to do. It’s going to be hard unless time and money are put in by either private parties or the government to be able to [do the research and] get the validation we need. So we’re not going to see very many [of these kinds] of updates.”

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Patient Safety Monitor.

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