Preventing surgical site infections

Abstract

The risk of surgical site infection (SSI) is approximately 1–3% for elective clean surgery. Apart from patient endogenous factors, the role of external risk factors in the pathogenesis of SSI is well recognized. However, among the many measures to prevent SSI, only some are based on strong evidence, for example, adequate perioperative administration of prophylactic antibiotics, and there is insufficient evidence to show whether one method is superior to any other. This highlights the need for a multimodal approach involving active post-discharge surveillance, as well as measures at every step of the care process, ranging from the operating theater to postoperative care. Multicenter or supranational intervention programs based on evidence-based guidelines, ‘bundles’ or safety checklists are likely to be beneficial on a global scale. Although theoretically reducible to zero, the maximal realistic extent by which SSI can be decreased remains unknown.

Keywords::

• antibiotic prophylaxis
• bundles
• multimodal approach
• prevention
• surgical site infection
• surveillance

Acknowledgement

The authors are indebted to Rosemary Sudan for editorial assistance.

Financing & competing interests disclosure

The cited intervention studies from the University of Geneva Hospitals were supported by the Swiss National Research Foundation, the Velux Foundation and institutional grants. The manuscript was presented in part at the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, CA, USA, on 13 September 2009. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.