Guideline Writers Issue Advisory Statement




Representatives from 11 national medical organizations that write guidelines related to surgical infection prevention met in January 2003 to explore possible areas for consensus-building. The forum allowed guideline writers to discuss and examine issues pertinent to the National Surgical Infection Prevention Project.
Pictured (left to right) are: E. Patchen Dellinger, MD, Infectious Disease Society of America; Christopher Daly, MD, American College of Surgeons; Peter Houck, MD, Centers for Medicare & Medicaid Services; Keith M. Olsen, PharmD, American Society of Health System Pharmacists; Dale W. Bratzler, DO, MPH, Oklahoma Foundation for Medical Quality; Gianna Zuccotti, MD, MPH, The Medical Letter; Fred H. Edwards, MD, Society of Thoracic Surgeons; Jason H. Calhoun, MD, American Academy of Orthopaedic Surgery; Vanessa Dalton, MD, MPH, American College of Obstetricians and Gynecologists; Donald E. Fry, MD, Surgical Infections Society; James T. Lee, MD, PhD, HICPAC; John A. Hitt, MD, Volunteer Hospitals of America; Chesley Richards, MD, MPH, Centers for Disease Control and Prevention. Not pictured: Robert A. Bonomo, MD, American Geriatrics Society.
The authors of all current North American surgical infection prevention guidelines — along with professional organizations that are involved in surgical care — recently released a joint advisory statement on infection prevention entitled “Antimicrobial Prophylaxis for Surgery: An Advisory Statement from the National Surgical Infection Prevention Project.”  It was published in the June 15, 2004, issue of the journal, Clinical Infectious Diseases.
“This advisory statement is the result of a year-long effort by leading national medical organizations to identify best practices for preventing surgical site infections,” said Peter Houck, MD, leader of Medicare’s National Surgical Infection Prevention Project. “We are pleased that this statement has been accepted by more than 20 medical societies and national health care organizations, including the American College of Surgeons, the American Academy of Orthopaedic Surgeons, and the Society of Thoracic Surgeons.”
The quality improvement project is co-sponsored by the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) and is conducted through the CMS Health Care Quality Improvement Program. Its goal is to reduce the occurrence of post-operative infection by improving the selection and timing of preventative antibiotic administration.
When the National Surgical Infection Prevention Project was launched in 2002, clinical experts identified areas of inconsistency among the existing surgical infection prevention practice guidelines, as well as issues that were not addressed in any of the guidelines. Areas of focus included selection of antibiotics for patients with certain antibiotic allergies, and the duration of antibiotic therapy after completion of the operation.
Project leaders hosted a forum of national medical organizations in January, 2003. The two-day meeting led to initial consensus concerning antibiotic selection, timing, and duration for select types of surgery. The resulting advisory statement was subsequently accepted by all of the participating organizations, as well as additional national medical organizations. Its most important features were recommendations that antibiotics used to prevent surgical infection should be given during the hour before surgery and that they should not be used for more than 24 hours after the end of the operation. Timely administration results in more effective infection prevention, while short duration is less likely to produce antibiotic-resistant bacteria.
Participating organizations were American Academy of Orthopaedic Surgeons, American College of Obstetricians and Gynecologists, American College of Surgeons, American Geriatrics Society, American Society of Health-System Pharmacists, Infectious Diseases Society of America, The Medical Letter, Society of Thoracic Surgeons, Surgical Infection Society, Society for Healthcare Epidemiology of America, and VHA, Inc.
Representatives of these and other organizations serve on the project’s expert panel. The expert panel meets monthly to provide clinical expertise and support to the CMS/CDC steering committee on project features, such as operations/procedures, quality indicators, support and collaboration. The expert panel comprises leading infectious disease and surgical experts representing more than 16 national organizations.
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