Surgical site infections: Prevalence, economic burden, and new preventive recommendations

Surgical site infections (SSIs) represent a significant challenge in healthcare, ranking as one of the most common healthcare-associated infections (HAIs). These infections not only adversely affect patient outcomes by increasing morbidity and mortality but also impose a substantial economic burden on healthcare systems worldwide. SSIs can manifest at the incision site, within deep tissues, or in organs, typically occurring within 30 days post-surgery or up to 90 days if prosthetic material is implanted.

The risk factors for SSIs are multifaceted, involving patient-related and surgical variables. According to the Centers for Disease Control and Prevention (CDC), patient-related risk factors include advanced age, obesity, diabetes, malnutrition, and immunosuppression. Surgical risk factors encompass the type of surgery, duration of the procedure, preoperative skin preparation, and the use of prophylactic antibiotics.

Evidence-based preventive measures can significantly reduce the incidence of SSIs. Research suggests that nearly half of all SSIs are preventable through the implementation of rigorous, evidence-based strategies. Multiple organizations, including the CDC, Japan Society for Surgical Infection (JSSI), National Institute for Health and Care Excellence (NICE), American College of Surgeons/Surgical Infection Society (ACS/SIS), and the World Health Organization (WHO), have developed comprehensive guidelines to aid in the prevention of SSIs.

CDC Guidelines: The CDC emphasizes several key preoperative measures:

1. Glycemic Control: Maintaining optimal blood glucose levels in diabetic and non-diabetic patients to reduce infection risk.
2. Normothermia: Ensuring patients maintain normal body temperature during surgery to enhance immune function and reduce infection rates.
3. Oxygenation: Providing adequate oxygen levels to promote tissue healing and immune response.
4. Antiseptic Prophylaxis: Using appropriate antiseptic agents for skin preparation before surgery to minimize bacterial load.

JSSI Guidelines: The JSSI guidelines provide detailed preventive measures for gastroenterological surgeries, covering:

1. Preoperative Measures: Preoperative nutritional optimization, proper patient education, and skin decolonization techniques.
2. Intraoperative Measures: Sterile techniques, appropriate antibiotic prophylaxis, and minimizing operating room traffic.
3. Postoperative Measures: Proper wound care, monitoring for signs of infection, and timely intervention if an infection is suspected.

NICE Guidelines: NICE offers comprehensive recommendations across all stages of surgery:

1. Preoperative Showering: Advising patients to shower with antiseptic soap before surgery.
2. Nasal Decolonization: Using mupirocin nasal ointment to reduce nasal carriage of Staphylococcus aureus.
3. Hair Removal: Preferring clipper use over razors to minimize skin abrasions.
4. Surgical Practices: Adhering to strict aseptic techniques, maintaining sterile environments, and proper hand hygiene.

ACS/SIS Guidelines: The ACS/SIS guidelines focus on both evidence-based and consensus-driven strategies:

1. Antibiotic Prophylaxis: Administering appropriate antibiotics within an hour before incision and discontinuing within 24 hours postoperatively.
2. Surgical Technique: Employing meticulous surgical techniques to reduce tissue trauma and blood loss.

WHO Guidelines: WHO emphasizes a global perspective on SSI prevention:

1. Global Implementation: Encouraging adherence to international best practices across diverse healthcare settings.
2. Multimodal Strategies: Integrating multiple preventive measures tailored to specific regional and institutional needs.

SSIs impose a substantial economic burden on healthcare systems due to prolonged hospital stays, additional surgical interventions, and increased use of antibiotics. Reducing SSI rates through effective preventive measures can lead to significant cost savings and improved patient outcomes.

SSIs are a pervasive issue in healthcare, with profound health and economic implications. Adhering to evidence-based guidelines and implementing comprehensive preventive measures are crucial to mitigating the risk of SSIs. Continued efforts in research, education, and policy development are essential to enhance the effectiveness of these preventive strategies and improve patient safety.

Full text:

https://www.xiahepublishing.com/2472-0712/ERHM-2023-00010

The study was recently published in the Exploratory Research and Hypothesis in Medicine.

Exploratory Research and Hypothesis in Medicine (ERHM) publishes original exploratory research articles and state-of-the-art reviews that focus on novel findings and the most recent scientific advances that support new hypotheses in medicine. The journal accepts a wide range of topics, including innovative diagnostic and therapeutic modalities as well as insightful theories related to the practice of medicine. The exploratory research published in ERHM does not necessarily need to be comprehensive and conclusive, but the study design must be solid, the methodologies must be reliable, the results must be true, and the hypothesis must be rational and justifiable with evidence.

Follow us on X: @xiahepublishing

Follow us on LinkedIn: Xia & He Publishing Inc.