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WHO launches global guidelines to stop surgical site infections

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5942 (Published 03 November 2016) Cite this as: BMJ 2016;355:i5942
  1. Anne Gulland
  1. London

Patients should not be shaved before surgery and should get antibiotics only before and during surgery, not afterwards, the World Health Organization has said.1

The advice is part of WHO’s first ever global guidelines on reducing surgical site infections (SSIs), a list of 29 recommendations to prevent infection before, during, and after surgery. They complement the surgical safety checklist launched by WHO in 2009.2

Ed Kelley, director of WHO’s department of service delivery and safety, said that shaving before surgery could increase the risk of SSIs and recommended clipping hair if absolutely necessary.

“Shaving has been a practice for many years. But the evidence shows that there is no clear benefit and shaving increases the risk of micro-abrasions to the skin or other small cuts,” he said.

The guidelines also stated that antibiotics should be given to patients 120 minutes before undergoing major or high risk surgery, such as bowel surgery or joint removal.

Sally Davies, chief medical officer for England, told a press conference at the launch of the guidelines that good infection control measures such as hand washing, the design of the operating theatre, and preparation of the patient were paramount in preventing infections.

“The use of antibiotics has to be subsidiary to all these,” she said.

There are no reliable global data on how many SSIs occur every year but WHO estimates that in low and middle income countries 11% of patients who undergo surgery become infected. It also said that in Africa 20% of women undergoing a caesarean section contract a wound infection.

The guidelines included 13 recommendations for the period before surgery, and 16 for preventing infections during and after surgery. They included recommendations that patients bathe or shower before surgery and that patients are warmed during the surgical procedure. There were norecommendations on the wearing of double gloves or changing gloves during an operation because of a lack of evidence.

Davies welcomed the guidelines.

“This is WHO at its best—these are evidence based, normative guidelines that are straightforward and simple to use,” she said.

Kelley added that the guidelines could be used in low and middle income countries as well as in high income ones.

“We didn’t put a recommendation in that wasn’t relevant to all member states,” he said.

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