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Surgical site infections: epidemiology and prevention
1Division of Critical Care and Trauma, Weill Medical College of Comell University, Ann and Max A Cohen Surgical Intensive Care Unit, New York-Presbyterian Hospital, New York, New York 10021, USA. pbarie@med.cornell.edu
Background:
The overall incidence of surgical site infection (SSI) has been estimated to be 2.8% in the United States, according to the U.S. Centers for Disease Control and Prevention, although the data may underrepresent the true incidence of such infections owing to inherent problems with voluntary self-reporting by surgeons of infections that occur in the ambulatory surgical setting. This review analyzes the reasons why patients are at risk and what can be done to minimize the risk.
Methods:
Review of the pertinent English-language literature.
Results:
Factors that contribute to the development of SSI include those that arise from the patient's health status, those that relate to the physical environment where surgical care is provided, and those that result from clinical interventions that increase the patient's inherent risk. Careful patient selection and preparation, including the judicious use of antibiotic prophylaxis, can decrease the overall risk of infection, especially following clean-contaminated and contaminated operations. However, antibiotics are not a substitute for attention to detail and meticulous surgical technique, and can increase the risk of nosocomial infection following injudicious use (that is, overuse).
Conclusion:
Most SSIs can be attributed to risk factors inherent to the patient, rather than to inherently flawed surgical care. Nonetheless, the surgeon can minimize the risk to the patient through careful patient selection and preparation, attention to technical details and awareness of the operating room environment, and the selective use of short-duration, narrow-spectrum antibiotic prophylaxis for appropriate patients.
Insights
Surgical site infections (SSIs) are often linked to patient-specific factors. Surgeons can reduce SSI risk through careful patient preparation, meticulous technique, and appropriate antibiotic use.
Area of Science:
- Infectious Disease
- Surgical Outcomes
- Public Health
Background:
- Surgical site infection (SSI) incidence is estimated at 2.8% in the US.
- Underreporting may occur due to voluntary self-reporting in ambulatory settings.
- This review examines patient risk factors and mitigation strategies for SSIs.
Purpose of the Study:
- To analyze patient risk factors for surgical site infections.
- To identify strategies for minimizing SSI risk.
- To provide insights into the prevention of SSIs.
Main Methods:
- Literature review of English-language publications.
- Analysis of factors contributing to SSI development.
- Evaluation of preventative measures.
Main Results:
- Patient health status, surgical environment, and clinical interventions are key risk factors.
- Antibiotic prophylaxis can reduce infection risk, especially in contaminated procedures.
- Meticulous surgical technique is crucial; antibiotics are not a substitute and overuse increases risks.
Conclusions:
- Most SSIs stem from patient-inherent risks, not solely flawed surgical care.
- Surgeons can minimize SSI risk via patient selection, preparation, and technical precision.
- Selective, short-term antibiotic prophylaxis is recommended for appropriate patients.