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Good patient and environmental hygiene and judicious use of antimicrobial therapy form the basis of new recommendations issued by the Centers for Disease Control and Prevention (CDC) for preventing surgical site infections.

Patients should shower or have a full-body bath at least the night before surgery, using soap (antimicrobial or non-antimicrobial) or an antiseptic agent, the recommendations state. Use of antimicrobial prophylaxis should adhere to published clinical guidelines, and, as indicated, administration should be timed to achieve bactericidal concentrations in serum and tissues at the time of the initial incision. Women undergoing cesarean section should receive antimicrobial prophylaxis before the incision.

Developed by the CDC Healthcare Infection Control Practices Advisory Committee and published online in , the guideline includes recommendations for skin preparation in the operating room, use of topical agents, glycemic control, oxygen management, and use of transfusion products.

The CDC guideline "is useful to every surgeon because it is brief and summarizes the recommendations, with their level of support," Pamela A. Lipsett, MD, program director of Surgical Critical Care at Johns Hopkins Medicine in Baltimore, said in an . "It tells us what we should do and what we do not know."

Unfortunately, though, she added, a majority (25) of the 42 statements in the guideline come with "no recommendation with respect to support or harm if the level of the evidence was low or very low or if [the authors] were unable to judge tradeoffs between harms and benefits of the proposed intervention because of lack of outcomes."

The guideline evolved from a literature review from 1998 through April 2014. Two independent reviewers conducted full-text reviews of 896 titles and abstracts, 170 of which were extracted into evidence, evaluated, and categorized. Recommendations that emerged from the review included:

• Use preoperative antimicrobial prophylaxis only as indicated by published clinical guidelines
• Do not apply topical antimicrobial agents to prevent surgical site infection
• Implement glycemic control perioperatively, and target a blood glucose level <200 mg/dL in diabetic and nondiabetic patients
• Maintain normal temperature control throughout the perioperative period
• Administer increased fraction of inspired oxygen during surgery and after extubation in the immediate postoperative period for patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation
• Perform intraoperative skin preparation with an alcohol-based antiseptic, unless contraindicated
• Do not withhold transfusion products as a means of preventing surgical site infection

The advisory committee that drafted the guideline acknowledged that "the number of unresolved issues in the guideline reveals substantial gaps that warrant future research. A select list of these unresolved issues may be prioritized to formulate a research agenda to advance the field."

Lipsett noted that guidelines "tell us what we can do (or not do) for most patients," and these CDC recommendations for preventing surgical site infection "do exactly that, and show us the way forward."