Reducing the risk of surgical site infections: embracing basic and innovative risk reduction strategies

E. Charles, JrEdmiston PhD, Candace J. Krepel MS, Patti J. Wilson BSN, Bonnie F. Grahn BSN, Patricia J. Sadenwasser BSN, Donna L. Welter BA, R. Gary. Seabrook MD

Surgical-site infections (SSIs) are associated with significant morbidity and mortality, especially in high-risk patient populations. The probability of a patient developing a postoperative SSI is influenced by selected intrinsic and extrinsic risk factors present at the time of surgery. It is estimated that between 750 000 and 1 000 000 SSIs occur in the USA each year, utilising 3.7 million extra hospital days and costing more than US$1.6 billion in excess hospital charges each year. The cornerstones for reducing the risk of SSI include exquisite surgical technique, timely and appropriate antimicrobial prophylaxis, effective and persistent skin antisepsis and identification of adjunctive strategies for reducing wound contamination while promoting wound healing. Historically, SSI surveillance was conducted in a retrospective manner, however efforts to implement a timely and effective infection control program requires a prospective interdisciplinary system for: (i) identifying selective and non-selective SSIs; and (ii) rapid implementation of appropriate interventional strategies designed to mitigate risk. In the USA, national efforts to reduce the morbidity and mortality of SSIs has resulted in the adoption of the Surgical Care Improvement Project, which focuses on four evidenced-based interventional strategies including glycaemic control in cardiothoracic and vascular patients, appropriate hair removal, timely and appropriate antimicrobial prophylaxis, and maintenance of normothermia in colorectal patients. Efforts to reduce the risk of SSI in the future will require a focussed, multidisciplinary commitment, embracing sentinel evidence-based strategies in addition to novel, yet effective, innovative risk reduction technologies.

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