Preventing Surgical Site Infections (original) (raw)

2010, AJN, American Journal of Nursing

Healthcare-associated infections (HAIs) are frequent on surgical wards [1,2] and represent a high burden on patients and hospitals [1,3] in terms of morbidity, mortality, prolonged length of hospital stay and additional costs [4]. Surgical site infections (SSIs) are an important source [1] and may even be the most frequent HAI after excluding asymptomatic bacteriuria [5]. Apart from endogenous risk factors, such as immune suppression [6-8], obesity [9] or advanced age [10], the role of external risk factors in SSI patho genesis is now clearly established [1,3]. Multimodal [11], multicenter or supranational preventive intervention programs based on guidelines [1,12], 'bundles' [13,14] or safety checklists [15] are gaining momentum on a global scale [16,17]. In parallel, randomized studies provide insight into poorly explored risk factors and practical intervention measures. The National Institute for Health and Clinical Excellence (NICE) in England, Wales and Northern Ireland issued guidance for the prevention and treatment of SSI [201] in October 2008, and the 1999 SSI guidelines of the CDC are currently under revision. We summarize the state-of-the-art regarding SSI prevention among adult inpatients, highlight important epidemiological features and discuss pitfalls of surveillance and the possible role of benchmarking SSI rates. The practical questions regarding the most effective measures to reduce SSI and the SSI rates achievable today are also addressed, as well as the theoretical possibility of achieving a zero SSI policy on a surgical ward, at least for clean orthopedic surgery [3]. Methods The aim of the research was to provide an overview of the current state-of-the-art of SSI prevention with an emphasis on literature published during the last 5 years, particularly the most recent. Landmark studies and important publications are incorporated for an overriding purpose. The first author performed a PubMed search of the literature to identify English, French and German language publications prior to 10 January 2010 using the following MeSH terms in various combinations: 'surgical site infection', 'nosocomial', 'surgery', 'ortho paedic', 'infection', 'prosthesis', 'arthroplasty', 'zero', 'prophylaxis', 'prevention', 'bundles' and 'guidelines'. The search was verified by the second and last author for pertinence to the topic. Reference lists of identified articles were searched manually to retrieve additional literature published after January 2004. Animal studies and studies with an outcome other than SSI, for example, colonization studies, in vitro studies and pediatric reports were excluded. We concentrated on articles with data on the post-discharge surveillance of SSI. A total of 205 articles were retained and form the basis of this review. Sterilization