Clinical Practice Guideline - Surgical Infection Issue Surgical Infection Issue

Clinical Practice Summary:

National Collaborating Centere for Women's and Children's Health. (2008, October; reaffirmed in 2011). Surgical site infection: prevention and treatment of surgical site infection. Lodnon (UK): National Institute for Health and Clinical Excellence (NICE).142 p. [256 references].

Scope and Purpose

The scope and purpose of the clinical practice guideline entitled "Surgical site infection: prevention and treatment of surgical site infection, is to provide guidance for surgical site infections (SSI). A surgical site infection is a wound that occurs when an invasive surgical procedure has taken place. The surgical site infection guideline does not address management of the operating theatre environment and environmental factors, nor does the surgical site infection guideline address prophylaxis and management of antibiotic-resistant bacteria. Anesthetic factors relating to the surgical site infection (SSI) are also not addressed by the surgical site infection guideline.

The objectives of the surgical site infection guideline are to provide an approach to intervention and practice that covers prevention, treatment, and management. Specifically, the guideline is intended to provide a structured approach to care with clear, consistent advice for caregivers and patients that addresses pre-operative procedures, the intraoperative phase, and post-operative procedures. The surgical site infection guideline considers the following outcome measures in its recommendations and guidelines for prevention, treatment, and management: 1) The incidence of surgical site infections (SSI); 2) wound healing time; 3) mobidity and mortality; 4) cost effectiveness, as measured by the cost per infection avoided and the cost per life saved each year.

Stakeholder Involvement

The methods used to formulate the recommendations for the guideline included expert consensus and informal consensus. Registered stakeholder organizations were given the opportunity to comment on the scope of the guideline in the early development and to comment...

Moreover, the Guideline Development Group (GDG), a working group consisting of lay people and professionals who represent different areas, developed the guideline. The Guideline Development Group was convened by the National Collaborating Centre for Women's and Children's Health (NCC-WCH). The membership in the stakeholder group included the following: Two surgeons, two microbiologists, a theatre nurse, a tissue viability nurse, an infection control specialist, a surveillance coordinator, and two patient / caregiver representatives. Inclusion of patient and caregiver representatives means that the target population was engaged in the development of the document. In 2011, the National Collaborating Centre for Women's and Children's Health completed a review of this guideline and determined it to be correct and the most current version of the guideline for surgical site infection. Possible conflicts of interest in the development of the surgical site infection guideline include loading the stakeholder group with professionals who are all engaged in some way with the pre-operative, inter-operative, and/or post-operative phases of surgical operations.
Rigor of Development

The clinical practice guidelines have strong credibility as they are created by multi-disciplinary teams of professionals and relevant stakeholders, any or all of whom may represent different clinical contexts. The data for the surgical site infection guidelines was collected through hand-searches of published literature (both primary and secondary sources) and searches of electronic databases. Systematic searches were employed for answering the clinical questions formulate and posed by the GDV. Stakeholder organizations were invited to bring evidence to the GDG for consideration as relevant to the topic and scope, and equivalent or better than evidence provided through search strategies. It is worth noting that grey literature was not part of the search strategy, and journals that were not indexed on the databases were not searched manually. An eight-level table of evidence types was employed to identify the level of evidence used in the study. The evidence types range from high quality meta-analyses and systematic reviews of randomized controlled trials (RCTs) or RCTs with a very low risk of bias, to expert opinion and formal consensus. Qualitative studies in the form of case series and other non-analytic reports are included. For each clinical question, the highest level of evidence available was selected for consideration in the guideline. The clinical evidences for the individual studies was synthesized for evidence table input and brief descriptions of each study were included in the guideline text. Both qualitative synthesis and quantitative synthesis (meta-analysis) was performed wherever sufficient research was identified to enable and merit these analyses.

Recommendations

For every clinical question considered, the recommendations were derived from and explicitly linked to…