To fight surgical superbugs, WHO recommends new guidelines

Surgical site infections caused by bacteria getting in to the body through incisions put millions of patients worldwide at risk each year and exacerbate the spread of antibiotic resistant superbugs.

Antibiotics encouraged before and during surgery, not afterwards

Thomson Reuters Posted: Nov 03, 2016 9:56 AM EDT | Last Updated: November 3, 2016

Surgical site infections contribute to patients spending some 400,000 extra days in hospital in the U.S., according to the World Health Organization. (Shutterstock)

Patients going for surgery shouldbathe or shower beforehand but their surgical site should not beshaved, and antibiotics should be used to prevent infectionsbefore and during surgery, but not afterwards, the World HealthOrganization says.

In new guidelines aimed at halting the spread of potentiallydeadly superbug infections in hospitals and clinics worldwide,the WHO said obsessive dedication to cleanliness and hygiene wascrucial, as was the careful use of anti-infectives.

Surgical site infections are caused by bacteria getting into the body through incisions made during surgery. They putmillions of patients worldwide at risk each year and exacerbatethe spread of antibiotic resistant superbugs such as MRSA.

"No one should get sick while seeking or receiving care,"Marie-Paule Kieny, the WHO's assistant director-general forhealth systems and innovation, said in a statement Thursday as the newrecommendations were published.

The guidelines range from simple precautions such asensuring patients take a bath or shower before surgery andensuring surgical teams use the best possible methods incleaning their hands, to advice on when to give antibiotics toprevent infections, what disinfectants are best before incision,and which sutures doctors should use.

Importantly, the guidelines recommend patients are givenantibiotics to prevent infections before and during surgery onlya measure the WHO described as crucial to slowing the spreadof antibiotic resistance. In a change to current commonpractice, the guidelines said antibiotics should not be usedafter surgery unless the patient has contracted an infection.

Invaluable tool to protect patients

"Preventing surgical infections requires a range ofpreventive measures. These guidelines are an invaluable tool forprotecting patients," Kieny said.

According to WHO figures, some 11 per cent of patients inpoor and middle-income countries who have surgery pick up aninfection during their operation. In Africa, up to a fifth ofwomen who have a caesarean section get wound infections.

But surgical site infections are not just a problem forpoorer countries. In the United States, according to the WHO,they contribute to patients spending some 400,000 extra days inhospital at an additional annual cost of an $900 million US.

Ed Kelly, a WHO service delivery and safety expert, notedthat some of the recommendations would mean reversing previouspractice, such as the shaving of body hair before surgery.

The new advice not to shave is based on extensive evidencethat shaving greatly increases the risk of micro-abrasions andsmall cuts in the skin, he said, which in turn raise the risk ofbacteria entering the body.

Kelly said the list of 29 recommendations, drawn up by 20international experts, were valid for any country and suitableto local adaptations, and take into account costs, resources andthe strength of available scientific evidence.

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WHO recommends 29 ways to stop surgical infections and avoid superbugs

To fight surgical superbugs, WHO recommends new guidelines

Antibiotics encouraged before and during surgery, not afterwards

Invaluable tool to protect patients

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