DISCLAIMER: These guidelines are intended to serve as a general statement regarding appropriate patient care practices based upon
available literature and clinical expertise at the time of development. They are not intended to replace clinical judgment or dictate practice.
Fast Facts – Guideline for Prevention of Surgical Site Infections
Preoperative Preparation of the Patient
 Do not remove hair preoperatively unless the hair around the incision site will interfere with the
operation.
 If hair is removed, remove immediately before the operation with electric clippers.
 Require patients to shower or bathe with an antiseptic agent (Chlorhexidine or Dial soap which
contains triclosan on at least the night before the operative day
Antimicrobial Prophylaxis
Overview: Administering pre-operative antibiotics prior to incision in certain procedures has been shown
an effective intervention targeted to reduce the risk of surgical wound infection thereby enhancing patient
safety.
 Appropriately administered antibiotic prophylaxis reduces the incidence of surgical wound
infection.
 Timing of antibiotic administration is critical to efficacy.
 First dose of antibiotic should be given before the procedure, ideally within 30 minutes but not
greater than 60 minutes before incision.
 First Antibiotic should NOT be given on the nursing unit but in the OR
 Cefazolin is the agent of first choice for clean procedures and provides adequate coverage for
many clean-contaminated procedures.
 Prophylactic antibiotics should be discontinued within 24 hours after surgery end time
The chart below summarizes the recommendations of several prospective, randomized controlled studies as
well as several systemic literature reviews addressing the use of prophylactic antibiotics in various surgical
procedures.
Procedure-Specific Recommendations for Antimicrobial Prophylaxis
Procedure
Biliary Tract (high risk only)
Cardiac
Colorectal
Recommended Antibiotic
Cefazolin
Cefazolin
Oral: Neomycin & Erythromycin
Base
AND
Neurosurgery
Craniotomy
Head and Neck
Hip/Knee Arthoplasty
Gynecologic and Obstetric
Vaginal or abdominal
hysterectomy
Thoracic (Non Cardiac)
Vascular
Adult Dose
1-2 grams IV
1-2 grams IV
1 gram of each agent at 19 hours,
18 hours and 9 hours before
surgery
Cefotetan or Cefoxitin OR
Cefazolin
+ Metronidazole
1-2 grams IV
1-2 grams IV
0.5 grams IV
Cefazolin
Cefazolin
OR
Clindamycin and
Gentamycin
Cefazolin
Cefazolin
OR
Cefotetan
OR
Cefoxitin
Cefazolin
Cefazolin
1-2 grams IV
1-2 grams IV
600-900 mg IV
1.5mg/kg IV
1-2 grams IV
1-2 grams IV
1 – 2 grams IV
1 gram IV
1-2 grams IV
1-2 grams IV
* For patients allergic to penicillins or cephalosporins, Vancomycin, 1 gram intravenously two hours before incision may be used
instead to provide activity against likely gram-positive organisms.
References:
1. Center for Disease Control Guideline. Hospital Infection Control Practices Advisory Committee:
Guideline for prevention of surgical site infection, 1999. Infect Control and Hosp Epidemiol 1999;
20(4): 247-78. Available online at http://www.cdc.gov/ncidod/hip/.
2. American College of Surgeons ACS Survey. Principles and practice. WebMD Corporation, 2002.
3. No author listed. Medical Letter - Medical Letter on Drugs and Therapeutics: Antimicrobial
prophylaxis in surgery 2001; 43:92-7
4. American Society of Health - System Pharmacists. ASHP therapeutic guidelines on antimicrobial
prophylaxis in surgery. American Society of Health – System Pharmacists. Am J Health Syst
Pharm 1999.Sept; 56(18): 421-68.
5. Dellinger EP, Gross PA, Barrett TL, Krause PJ, Martone WF, McGowan FE, Sweet RL, Wenzel
RP. Quality standard for antimicrobial prophylaxis in surgical procedures. Release in 1994
(reviewed in 1998). Clin Infect Dis 1994 Mar; 18(3): 422-7. Infect Control Hosp Epidemiol 1994
Mar;(15): 3.
6. Kjonniksen, I, Andersen BM, Sondenaa VG, Segadal L. Preoperative hair removal – a systemic
literature review. AORN 2002. May; 75(5): 928-40.
7. Dellinger EP. Preventing surgical site infection – the importance of timing and glucose control.
Infect Cont Hosp Epidemiol 2001; 22:604-06.