SURGICAL SITE INFECTIONS

[Date of last update: January 2022]

Surgical site infections (SSIs) are among the most common and frequent healthcare-associated infections in both Europe and the United States.  
All patients undergoing surgery are at risk of developing intra and postoperative complications. SSIs are associated with prolonged hospital stay, may require additional surgery, may include ICU admission, and in many cases have a significant impact on mortality. [1]

The incidence of SSI in the European Union has been estimated at 543 149 cases per year, based on data from the Prevalence Study on Healthcare-associated Infections and Antibiotic Use in ECDC (European Center for Disease Prevention and Control) of 2011-2012 (ECDC PPS). [2] 

There are many risk factors that contribute to exposing the patient to the onset of SSI, including endogenous and exogenous factors, the latter associated with the local processes and procedures of the individual health facilities. Some factors are not modifiable such as the sex and age of the patient. These risk factors include the patient's nutritional status, tobacco use, high body mass index (BMI), diabetes, prolongation of surgery, length of hospitalization before surgery> 2 days, ASA score> 3, presence of contaminated-dirty versus clean surgery, time and method of administration of antibiotic prophylaxis.

In the article published in JAMA Insights - Clinical Update [3], in 2020, it is highlighted how surgical site infections (SSI ) occur in up to 5% of patients after a surgical procedure, increasing the average length of hospital stay by 9.7 days, the risk of mortality by 2 to 11 times, and hospitalization costs by more than $ 20,000 per hospitalization.  SSIs can be defined, according to the CDC Atlanta classification [4], as superficial (confined to the skin or subcutaneous tissue), deep (involving the muscular or fascial layers) or organ-space (involving the internal anatomical region where the operation was performed). Since more than half of SSIs are estimated to be preventable with evidence-based guidelines, SSIs have been identified as an important indicator of quality.

 This article also assessed the guidelines produced by the American College of Surgeons (ACS) and the Surgical Infection Society (SIS; 2016), by the World Health Organization (WHO; 2016 guideline, amended in 2018) ) and that of the Centers for Disease Control and Prevention (CDC; 2017) and analyzed the interventions with the strongest recommendations to prevent SSI, present in all the guidelines. The recommendations can be summarized as follows:  
- antimicrobial prophylaxis 
- skin antisepsis  
- glycemic control  
- normothermia  
– maintenance of normal tissue oxygenation.

In recent years, interventions to prevent SSI have improved the safety of patient care, however, SSIs still are an important quality indicator that has implications for patients, surgeons and health institutions. SSI research continues on a global scale, pushing the frontier of SSI prevention and improving patient care.