WHO issues new guidelines on stopping surgical infections

The World Health Organisation (WHO) has issued new guidelines on how to stop surgical site infections, including one which discourages use of antibiotics after surgery.

"People preparing for surgery should always have a bath or shower but not be shaved, and antibiotics should only be used to prevent infections before and during surgery, not afterwards, according to new guidelines from WHO that aim at saving lives, cutting costs and arresting the spread of superbugs.

The guidelines recommend that antibiotics be used to prevent infections before and during surgery only, a crucial measure in stopping the spread of antibiotic resistance. Antibiotics should not be used after surgery, as is often done, a press release issued today (Nov 3) from Geneva said.

Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines. Resistance develops naturally over time, but misuse of antibiotics in humans and animals is rapidly accelerating the process.

Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance, the release said.  

"In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies," the release added.

The "Global Guidelines for the Prevention of Surgical Site Infection" includes a list of 29 concrete recommendations distilled by 20 of the world's leading experts from 26 reviews of the latest evidence.

The recommendations, according to the release, are designed to address the increasing burden of health care associated infections on both patients and health care systems globally.

The release explained that the new WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences. "They complement WHO's popular "Surgical Safety Checklist", which gives a broad range of safety measures, by giving more detailed recommendations on preventing infections."

WHO's Assistant Director-General for Health Systems and Innovation, Dr Marie-Paule Kieny said, "No one should get sick while seeking or receiving care." "Preventing surgical infections has never been more important but it is complex and requires a range of preventive measures. These guidelines are an invaluable tool for protecting patients."

The guidelines include 13 recommendations for the period before surgery, and 16 for preventing infections during and after surgery. They range from simple precautions such as ensuring that patients bathe or shower before surgery and the best way for surgical teams to clean their hands, to guidance on when to use antibiotics to prevent infections, what disinfectants to use before incision, and which sutures to use.

The Director of WHO's Department of Service Delivery and Safety, Dr Ed Kelley said, "Sooner or later many of us will need surgery, but none of us wants to pick up an infection on the operating table."

"By applying these new guidelines surgical teams can reduce harm, improve quality of life, and do their bit to stop the spread of antibiotic resistance," he said.

"We also recommend that patients preparing for surgery ask their surgeon whether they are following WHO's advice," Kelley added.