Surgical Site Infections

Any Breach of Patient Skin Can Lead To an Infection

Surgical site infections (SSIs) initiated during invasive procedures can require additional and/or extended treatment. Despite the best efforts of healthcare facilities to maintain safe surgical environments, surgical site infections result in up to $10 billion in treatment costs every year in the U.S. alone.

  • 780,000 out of 30 million surgical procedures performed annually in the U.S. result in SSIs1
  • 38% of all nosocomial infections in surgical patients are SSIs2
  • 14 to 16% of all nosocomial infections are SSIs2
  • 2 to 5% of patient operations will develop SSIs2
  • SSIs increase the patient’s length of stay in the hospital by an average of 7.5 days2

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Some common causes of SSI are:

  • Complications from surgical hypothermia
  • Contamination of the incision area by skin flora
  • Bacterial cross–contamination
  • Surgical instrument contamination

Some common causes of SSI are:
According to the Institute for Healthcare Improvement (IHI), effective surgical infection prevention requires redesigning systems to reduce risk factors and to optimize evidence-based processes of care.

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The following information was adapted from the Institute for Healthcare Improvement website:www.ihi.org

  • Identify and treat any pre-existing infections
  • Encourage patients to stop smoking as soon as surgery is anticipated
  • Control blood glucose in all diabetics and maintain postoperative glucose control for major cardiac surgery patients
  • Avoid operative site hair removal; use clippers if necessary
  • Use prophylactic antibiotics appropriately
  • Maintain perioperative normothermia for colorectal surgery patients
  • Follow Centers for Disease Control SSI Prevention Guideline Category IA recommendations
  • Educate patients on proper incision care and prompt reporting of signs indicating possible SSI

Resources & Tools

Research & Reports

Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission (Anesthesia & Analgesia)

Contaminating bacteria are commonly present on the hands of anesthesia providers and found high rates of transmission to the surgical field during operations. Led by Randy Loftus of Dartmouth-Hitchcock Medical Center, researchers conducted a study to pinpoint the origin of bacteria transmitted to the surgical field in 164 operating room procedures using general anesthesia. Loftus and colleagues used culture tests to determine that bacteria were transmitted to the stopcock valves of the intravenous lines in 11.5 percent of procedures. In almost half of those instances, the bacteria discovered in the intravenous lines were the same as those found on the hands of anesthesia providers, including attending anesthesiologists, residents and nurse-anesthetists

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Postoperative Hyperglycemia and Surgical Site Infection in General Surgery Patients (Archives of Surgery)

Postoperative high blood sugar levels may increase the risk for infection at the surgical site in patients having general surgery. The study examined 1,561 patients, including 559 who had vascular surgery, 226 who had colorectal surgery and 776 who had a type of general surgery other than colorectal. Age, emergency status, physical status as classified by the American Society of Anesthesiologists, time in surgery, diabetes and high postoperative blood glucose were all factors that appeared to be associated with surgical site infections, but factors other than postoperative blood glucose level were not significant predictors of infection. "In conclusion, we found postoperative hyperglycemia to be the most important risk factor for surgical site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110 milligrams per deciliter were associated with increasingly higher rates of post-surgical infection," the researchers wrote.

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Effect of an Implantable Gentamicin-Collagen Sponge on Sternal Wound Infections Following Cardiac Surgery (JAMA)

Duke University Medical Center researchers said they found that surgically implanted antibiotic-infused sponges do not reduce the rate of sternal wound infections in patients who have had heart surgery. Gentamicin-collagen sponges, approved in 54 countries, not including the U.S., are used in more than 1 million people. The study of 1,502 heart surgery patients found there was no significant difference in the overall rates of sternal wound infections between people who received sponges and those who did not.

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Lessons from the Pioneers Reporting Healthcare-Associated Infections (National Conference of State Legislatures)

The National Conference of State Legislatures has released a new report that offers lessons on infection-reporting data from nine of the states that first required medical facilities to report health care-associated infections. The NCSL looked at state laws passed from 2005 to 2009 and interviewed state lawmakers, health care providers and other related groups in Alabama, Colorado, Delaware, Illinois, Massachusetts, New Hampshire, Oregon, Pennsylvania and Washington. Since 2005, the number of states that require health care facilities to report HAIs has jumped from six to 27.

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Gentamicin–Collagen Sponge for Infection Prophylaxis in Colorectal Surgery (New England Journal of Medicine)

Leaving an antibiotic-soaked collagen sponge in the wound after colorectal surgery "paradoxically" seemed to cause an increase in surgical site infections. The findings of Elliott Bennett-Guerrero of Duke Clinical Research Institute in Durham, N.C., and colleagues opposed findings of an earlier study that identified a 70 percent decrease in such infections with the use of a gentamicin-collagen sponge. The study involved 602 patients undergoing open or laparoscopically assisted colorectal surgery at 39 U.S. sites.

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Anesthetic Management and Surgical Site Infections in Total Hip or Knee Replacement: A Population-based Study (Anesthesiology)

Epidrual or spinal anesthesia may help curb the risk of surgical site infection when compared with the use of general anesthesia in patients undergoing total joint replacement surgery. In an editorial on the study, Daniel I. Sessler of the Cleveland Clinic Anesthesiology Institute’s Department of Outcomes Research, said the findings provide compelling epidemiologic evidence that neuraxial anesthesia reduces the risk of SSIs. The study examined 3,081 patients in Taiwan who underwent total knee and total hip replacement procedures, and it showed that SSI rates within 30 days of the procedure was 2.2 times greater in patients who had general anesthesia.

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Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure (Infection Control and Hospital Epidemiology)

Patients who have had major chest or head operations are at an increased risk of developing post-surgical staphylococcus aureus infections. The findings are based on a review of 81,267 patients who underwent 96,455 orthopedic, cardiothoracic, plastic surgery or neurosurgery procedures at nine locations between 2003 and 2006. There were 454 staph infections among the patients, with the highest rates of bloodstream infections occurring in patients who had chest surgery, while the highest rates of surgical site infections occurred in patients who had brain operations. Deverick Anderson, lead author from Duke University Medical Center, said additional preventions for cardiovascular or neurosurgical procedures may be needed.

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Clinical and Financial Outcomes Due to Methicillin Resistant Staphylococcus aureus Surgical Site Infection: A Multi-Center Matched Outcomes Study (PLosOne)

The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.

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