CDC updates surgical site infection guidelines

APIC: Lack of guidance could affect pt safety

The Centers for Disease Control and Prevention has updated guidelines for preventing surgical-site infections, focusing on some difficult issues in an exhaustive and largely futile attempt to find conclusive data on various practices. As a result, "no recommendation" is a recurrent theme in the document, which was the work of the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC).

While that may be a completely accurate reflection of the dearth of data on many infection control issues, as a practical matter it leaves the infection preventionist with little to work with in trying to improve patient safety.

Comments from APIC

In comments submitted to the CDC, the Association for Professionals in Infection Control and Epidemiology (APIC) made similar points and requested a "plan of action" to provide practical guidance over a wider range of infection control issues.

"Our main concern is that the methodology used to create the document has resulted in significantly fewer practice recommendations than were in the 1999 SSI Guidelines," APIC stated. "… Although we understand the importance of scientific rigor and the need to develop a springboard for future research needs, we are faced with the concern that the application of these guidelines by healthcare professionals has the potential to lead to great confusion on topics for which there are limited or absent recommendations."

Another concern is the body of evidence that was excluded from the document due to an exclusive reliance on systematic reviews and randomized controlled trials, APIC noted.

"This approach does not provide practical guidance to healthcare providers at the bedside, which may then result in lack of standardization and regression to less safe practices and, potentially, in poor outcomes for patients," APIC warned. "… Due to limitations in scope, we fear that many professionals will misunderstand the statement No recommendations’ and revert back to traditional or unstudied practices."

In addition, APIC questioned the inclusion of clinical practice guidelines from various surgical societies and specialties as a supplement to the guidelines. "[T]he information has the potential to confuse readers as many sections are now in conflict with recommendations made in this document. If this section is to be included, reasoning as to the differences, i.e. the differing review methodologies and influence of regulatory and governing bodies on evidence building, needs to be included."