Grand Rounds

Update on preventing surgical site infections

By Daniel A. Anaya, MD, and E. Patchen Dellinger, MD

Here's what you need to know to identify patients at higher risk for SSIs and provide effective preventive strategies. These measures include good glucose control and well-timed prophylactic antibiotics.

We've long known that asepsis, antisepsis, and prophylactic antibiotics play a major role in reducing surgical wound infections. Even so, surgical site infections (SSI) will always be around to some degree and call for additional preventive strategies.

The third most common nosocomial infection in the United States, SSIs account for 38% of all infections in the 27 million patients who undergo surgery each year.¹ SSI rates for abdominal hysterectomy range from 0.5% to 5.3% depending on risk category, according to the National Nosocomial Infection Surveillance System (NNIS) data for 1992–2003.² Moreover, these infections extend hospital stays by up to 10 days—and that alone can drive up costs significantly.^1-4 But the good news is that specific strategies can significantly decrease these costs. One study that examined the cost-effectiveness of instituting such measures estimated that up to $3 million could be saved over a 10-year period, through reducing SSI rates by up to 56%.⁵

The growing interest in SSIs is likely due to the greater complexity of operations, the higher number of surgical patients who are older or immune-compromised (AIDS, cancer, transplants, etc.) with significant co-morbidities, and increasing use of implanted foreign body materials.