2023 Chinese Evidence-Based Guideline: Prevention and Management of Perioperative Infection (English Version)

Basic Information

• Full English Title: Evidence-based guideline for the prevention and management of perioperative infection
• Chinese Title: 2023 中国循证指南：围术期感染的预防和管理
• Issuing Body: Chinese Expert Group on General Surgery
• Lead Institution: Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University (jointly developed with 51 medical institutions and research institutes)
• Publication Date: February 28, 2023
• Journal: Journal of Evidence-Based Medicine
• DOI: https://onlinelibrary.wiley.com/doi/10.1111/jebm.12514
• Core Recommendations: 37 total (16 strong recommendations, 18 weak recommendations, 2 ungraded opinions)
• Methodology: Developed using the GRADE system, with grading via Delphi method and nominal group technique

Core Background & Purpose

Key Recommendations (Highlights)

1. Preoperative Management

• Blood glucose control: Maintain perioperative blood glucose < 10 mmol/L (strong recommendation, 1A)
• Anemia & hypoproteinemia: Correct preoperative anemia (Hb < 90 g/L) and hypoalbuminemia (Alb < 30 g/L) (strong recommendation, 1B)
• MRSA decolonization: Intranasal mupirocin 2% ± chlorhexidine gluconate bathing for nasal MRSA carriers (strong recommendation, moderate evidence)
• Preoperative stay: Minimize preoperative hospital stay to reduce SSI risk (strong recommendation, 1C)

2. Intraoperative Antimicrobial Prophylaxis

• Timing: Administer 30–60 min before incision (15–60 min before cord clamping for cesarean section) (strong recommendation, 1A)
• Choice by surgery type:
  • General clean surgery: 1st-generation cephalosporins (strong recommendation, 1A)
  • Cesarean section: 1st/2nd-generation cephalosporins ± metronidazole, or cefmetazole (weak recommendation, 2C)
  • Orthopedic/joint replacement: 1st-generation cephalosporins; local vancomycin for high-risk (MRSA, revision) cases (weak recommendation, 2B)
  • Hepatobiliary/genitourinary: 2nd-generation cephalosporins or fluoroquinolones (cover Enterobacteriaceae, Enterococcus, anaerobes)
   
• Redosing: Intraoperative redosing for prolonged surgery (> 3 h) or major blood loss (> 1,500 mL) (strong recommendation, 1B)

3. Postoperative Management

• Duration: Prophylaxis ≤ 24 h (≤ 48 h for cardiothoracic surgery) (strong recommendation, 1A)
• Drain removal: Remove surgical drains as early as feasible (weak recommendation, 2C)
• Infection control: Strict hand hygiene, environmental cleaning, and staff health monitoring (strong recommendations)

4. Infection Control & Staff Practices

• Hand hygiene: Comply with WHO 5 Moments (strong recommendation, 1A)
• Double gloving: For high-risk procedures (strong recommendation, 1B)
• Disinfectants: Use alcohol-based hand rubs and appropriate surface disinfectants (strong recommendation,