What lies beyond the current guidelines?
Recent statistics show that surgical site infections occur in approximately 5 percent of patients after inpatient surgery. While they may not seem like a large or significant percentage, let’s take a closer look at the effects:
- Infections increase the average hospital length of stay by 9.7 days,
- Infection increase risk of mortality, making it anywhere from two to 11 times more likely depending on extenuating circumstances;
- and infection increases costs of hospitalization by more than $20,000 per admission
A team of Boston-based surgeons led by Adam C. Fields, MD, Veterans Affairs Boston Healthcare System highlighted particularly strong interventions in a recent JAMA Insights article.
SSIs are defined as either superficial (confined to the skin or subcutaneous tissue), deep (involving the muscle or fascia layers), or organ-space (involving the internal anatomic region where the operation was performed). Because more than half of SSIs are estimated to be preventable with evidence-based guidelines, SSI has been identified as an important quality indicator and is now a pay-for-performance metric.
In emphasizing the importance of this patient safety issue, four major organizations—the American College of Surgeons (ACS) and Surgical Infection Society (SIS; 2016), the World Health Organization (WHO; 2016 guideline modified in 2018), and the Centers for Disease Control and Prevention (CDC; 2017)—published SSI prevention guidelines within one year of each other.
The strongest recommended guidelines included:
- parenteral antimicrobial prophylaxis
- alcohol-based skin preparation
- perioperative glycemic control
- temperature regulation to normothermia
- maintenance of normal tissue oxygenation
The researchers also highlighted some emerging guidelines that may have impacts on the prevention of surgical infections, such as uniform surgical attire and the questioning of the administration of intravenous antibiotics for all operations.
“Surgical site infection remains an important quality indicator that has implications for patients, surgeons, health care institutions, and payers,” the authors concluded.
