Prevention of Infection After Gynecologic Procedures
Publication Date: June 1, 2018
Last Updated: March 14, 2022
Recommendations
Implement perioperative glycemic control and use blood glucose target levels of less than 200 mg/dL in patients with and without diabetes. (A)
574
Perform preoperative surgical site skin preparation with an alcohol-based agent unless contraindicated. Chlorhexidine–alcohol is an appropriate choice. (A)
574
Patients undergoing vaginal, abdominal, laparoscopic, or robotic hysterectomy, including supracervical hysterectomy, should receive single-dose antimicrobial prophylaxis. (A)
574
Routine antibiotic prophylaxis is not recommended before IUD insertion. (A)
574
Antimicrobial prophylaxis should be administered to women undergoing uterine evacuation for induced abortion. (A)
574
Advise patients to shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before abdominal surgery. (B)
574
Antibiotic prophylaxis is not recommended for routine hysteroscopic procedures. (B)
574
Routine antibiotic prophylaxis is not recommended for women undergoing urodynamic testing. (B)
574
All infections remote to the surgical site, such as skin or urinary tract infections, should be identified and treated before an elective operation. Elective operations on patients with remote site infections should be postponed until the infection has resolved. (C)
574
Hair should not be removed preoperatively unless the hair at or around the incision site will interfere with the operation. Any necessary hair removal should be done immediately before the operation, preferably with electric clippers. A razor should not be used. Patients should be instructed not to shave the operative site themselves because shaving with a razor increases their risk of infection. (C)
574
Vaginal cleansing with either 4% chlorhexidine gluconate or povidone–iodine should be performed before hysterectomy or vaginal surgery. (C)
574
Administer an appropriate dose of antibiotic. For most antibiotics, including cefazolin, prophylaxis should be administered within 1 hour before skin incision. If quinolones or vancomycin are necessary, up to 2 hours is allowable. (C)
574
Prophylactic antibiotic dosage should be increased in obese patients. (C)
574
For lengthy procedures, additional intraoperative doses of an antibiotic, given at intervals of two times the half-life of the drug measured from the initiation of the preoperative dose, not from the onset of surgery, are recommended to maintain adequate levels throughout the operation. (C)
574
In surgical cases with excessive blood loss, a second dose of the prophylactic antibiotic may be appropriate. (C)
574
Routine use of antibiotic prophylaxis is not recommended for patients undergoing sonohysterography. (C)
574
Antimicrobial prophylaxis should be administered to women undergoing uterine evacuation for early pregnancy loss. (C)
574
For patients with a history of or known MRSA colonization or infection who are undergoing a procedure through a skin incision, use of a hospital-recommended MRSA antibiotic prophylaxis protocol or adjustment of the preoperative prophylactic antibiotic regimen to include a single preoperative intravenous dose of vancomycin is recommended. (C)
574
Patients undergoing procedures in which antimicrobial prophylaxis is recommended may receive a cephalosporin if they do not have a history of an immediate hypersensitivity reaction (anaphylaxis, urticarial, bronchospasm) to penicillin. The combination of metronidazole or clindamycin plus gentamicin or aztreonam is recommended for patients in whom cephalosporins are contraindicated. (C)
574
Recommendation Grading
Overview
Title
Prevention of Infection After Gynecologic Procedures
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
June 1, 2018
Last Updated Month/Year
April 1, 2024
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Ambulatory, Hospital
Intended Users
Physician, nurse midwife, nurse, epidemiology infection prevention, nurse practitioner, physician assistant
Scope
Prevention
Diseases/Conditions (MeSH)
D019072 - Antibiotic Prophylaxis, D011251 - Pregnancy Complications, Infectious
Keywords
infection prevention, Antibiotic prophylaxis, surgical site infection, gynecologic procedures