Surgical Sites Top List of Hospital-Acquired Infections

Laird Harrison

October 15, 2013

SAN FRANCISCO — Surgical-site complications are the most common hospital-acquired infections, a new study shows.

"There has been a lot of attention given to hospital-acquired infections, but much of it has focused on central-line-associated infections and catheter-associated urinary tract infections," said lead author Sarah Lewis, MD, a medical instructor at Duke University in Durham, North Carolina.

This study suggests that more resources should be devoted to surgical-site infections. "Especially in a situation of limited resources, we need to prioritize where we spend our research dollars in terms of preventing hospital-acquired infections," she told Medscape Medical News.

Dr. Lewis presented the study results here at IDWeek 2013.

Her team counted the number of infections acquired in a network of 15 hospitals participating in the Duke Infection Control Outreach Network.

The surveillance period — from January 1, 2010 to June 30, 2012 — involved 100,499 surgical procedures, 135,716 intensive care unit patient-days, and 1,596,277 nonintensive care unit patient-days.

Surgical-site infections were included if they occurred within 30 days of a procedure and did not involve implanted material, or if they occurred within 90 days of a procedure and involved implanted material. Other types of infection were only included if they were identified during the surveillance period.

Overall, the researchers identified 2345 hospital-acquired infections.

Table. Hospital-Acquired Infections

Infection n %
Surgical site 882 38
Catheter-associated urinary tract 611 26
Hospital-associated Clostridium difficile 514 22
Central-line-associated bloodstream 280 12
Ventilator-associated pneumonia 58 2


"The risk of developing a surgical-site infection is relatively low," said Dr. Lewis. The overall rate was 0.82 surgical-site infections per 100 procedures. However, "because there are so many surgeries, it is not surprising that surgical-site infections are on top," she said.

Efforts are underway to reduce the number of these infections, she explained. For example, the Surgical Care Improvement Project (SCIP) of The Joint Commission has developed measures to encourage the use of sterile techniques, proper skin preparation, and prophylactic antibiotics.

"SCIP is mandated by the Centers for Medicare and Medicaid Services, so there's relatively good compliance, but it has not had as much effect as we would hope," said Dr. Lewis. "We need to expand our thinking outside the box."

Deborah Yokoe, MD, from Harvard University in Boston, told Medscape Medical News that surgical-site infections are relatively numerous because so much surgery takes place in hospitals.

"It was not surprising to me that surgical-site infections make up a larger piece of the pie," said Dr. Yokoe, who was not associated with the work.

The researchers "make a very good point that we focus so much on these other types of infections. We need to focus on surgical-site infections," she said.

The US Healthcare Infection Control Practices Advisory Committee is poised to issue new guidelines on surgical-site infections, she noted.

But Dr. Yokoe said she agrees with Dr. Lewis that more research would help.

"There is still a paucity of evidence about how to prevent surgical-site infections and how to implement some of the practices that prevent them," she said.

Dr. Lewis and Dr. Yokoe have disclosed no relevant financial relationships.

IDWeek 2013. Abstract 497. Presented October 3, 2013.


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