Preventing Surgical Site Infections

Ilker Uçkay; Stephan Harbarth; Robin Peter; Daniel Lew; Pierre Hoffmeyer; Didier Pittet

Disclosures

Expert Rev Anti Infect Ther. 2010;8(6):657-670. 

In This Article

Abstract and Introduction

Abstract

The risk of surgical site infection (SSI) is approximately 1–3% for elective clean surgery. Apart from patient endogenous factors, the role of external risk factors in the pathogenesis of SSI is well recognized. However, among the many measures to prevent SSI, only some are based on strong evidence, for example, adequate perioperative administration of prophylactic antibiotics, and there is insufficient evidence to show whether one method is superior to any other. This highlights the need for a multimodal approach involving active post-discharge surveillance, as well as measures at every step of the care process, ranging from the operating theater to postoperative care. Multicenter or supranational intervention programs based on evidence-based guidelines, 'bundles' or safety checklists are likely to be beneficial on a global scale. Although theoretically reducible to zero, the maximal realistic extent by which SSI can be decreased remains unknown.

Introduction

Healthcare-associated infections (HAIs) are frequent on surgical wards[1,2] and represent a high burden on patients and hospitals[1,3] in terms of morbidity, mortality, prolonged length of hospital stay and additional costs.[4] Surgical site infections (SSIs) are an important source[1] and may even be the most frequent HAI after excluding asymptomatic bacteriuria.[5] Apart from endogenous risk factors, such as immune suppression,[6–8] obesity[9] or advanced age,[10] the role of external risk factors in SSI pathogenesis is now clearly established.[1,3] Multimodal,[11] multicenter or supranational preventive intervention programs based on guidelines,[1,12] 'bundles'[13,14] or safety checklists[15] are gaining momentum on a global scale.[16,17] In parallel, randomized studies provide insight into poorly explored risk factors and practical intervention measures. The National Institute for Health and Clinical Excellence (NICE) in England, Wales and Northern Ireland issued guidance for the prevention and treatment of SSI[201] in October 2008, and the 1999 SSI guidelines of the CDC are currently under revision.

We summarize the state-of-the-art regarding SSI prevention among adult inpatients, highlight important epidemiological features and discuss pitfalls of surveillance and the possible role of benchmarking SSI rates. The practical questions regarding the most effective measures to reduce SSI and the SSI rates achievable today are also addressed, as well as the theoretical possibility of achieving a zero SSI policy on a surgical ward, at least for clean orthopedic surgery.[3]

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