WHO ASA Global Guidelines Overview - American Society of Anesthesiologists (ASA)

WHO ASA Global Guidelines Overview

GLOBAL GUIDELINES FOR THE PREVENTION OF SURGICAL SITE INFECTION
Top Five Relevant Guidelines for Physician Anesthesiologists

Dear Member,

The World Health Organization (WHO) recently released its Global Guidelines for the Prevention of Surgical Site Infection. The Committee on Quality Management and Departmental Affairs (QMDA) has completed review of this lengthy report and has provided the top five points that are of highest interest to physician anesthesiologists and the anesthesia care team. The original report, the Global Guidelines on the Prevention of Surgical Site Infection, and the additional guidelines can be found here.

The five points that are the most relevant to anesthesia include: perioperative oxygenation, normothermia, glucose control, normovolemia and antibiotic timing.  The perioperative oxygenation guideline may be the parameter most worth review as it may involve changes in intraoperative practice as well as alterations in Post-Anesthesia Care Unit (PACU) protocols.

We hope this brief synopsis will help your clinical practice as well as increase your understanding and appreciation of the many parameters the entire surgical team are attempting to manage to prevent surgical site infections. We suggest you review the evidence listed behind each recommendation. We’ve listed the corresponding references pages in the report next to each standard. 

Respectfully, 

The Committee on Quality Management & Departmental Administration 

GLOBAL GUIDELINES FOR THE PREVENTION OF SURGICAL SITE INFECTION

Top Five Relevant Guidelines for Physician Anesthesiologists

 
The following five guidelines have been extracted from Table 1 of the Global Guidelines for the Prevention of Surgical Site Infection. This can be found on page 16.

Topic

Research Questions

Recommendations

Strength

Quality of Evidence

Reference Page Numbers

Perioperative Oxygenation

How safe and effective is the perioperative use of an increased fraction of inspired oxygen in reducing the risk of SSI?

The panel recommends that adult patients undergoing general anaesthesia with

endotracheal intubation for surgical procedures should receive an 80% fraction of inspired oxygen

intraoperatively and, if feasible, in the immediate postoperative period for 2-6 hours to reduce the risk of SSI.

Strong

Moderate

113-115

Maintaining

normal body

temperature (normothermia)

Should systemic body warming vs. no warming be used for the

prevention of SSI in surgical patients?

The panel suggests the use of warming devices in the OR and during the surgical procedure for patient body warming with the purpose of reducing SSI.

Conditional

Low

118-119

Use of protocols for intensive

Perioperative blood glucose control

1. Do protocols aiming to maintain optimal perioperative blood glucose levels reduce

the risk of SSI?

2. What are the optimal perioperative glucose target levels in diabetic and non-diabetic patients?

The panel suggests the use of protocols for intensive perioperative blood glucose control for both diabetic and non-diabetic adult patients undergoing surgical procedures to reduce the risk of SSI. The panel decided not to formulate a recommendation on this topic due to the lack of evidence to answer question 2.

Conditional

Low

123-125

Maintenance of adequate circulating volume control/ normovolemia

Does the use of specific fluid management strategies during surgery affect the incidence of SSI?

The panel suggests the use

of goal-directed fluid

therapy intraoperatively to

reduce the risk of SSI.

Conditional

Low

128-130

Optimal timing for preoperative surgical antibiotic prophylaxis (SAP)

How does the timing of SAP administration impact on the risk of SSI and what is the precise optimal timing?

The panel recommends that SAP should be administered prior to the surgical incision when indicated (depending on the type of operation).

Strong

Low

74-75

The panel recommends the administration of SAP within 120 minutes before incision, while considering the half-life of the antibiotic.

Strong

Moderate

74-75

 


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