Reduce Post-Op Contamination Risk

SSIs are among the most common healthcare-associated infections (HAIs), accounting for up to 21.8% of HAIs according to a study by Magill et al.[4] SSIs not only cause increased morbidity and mortality for patients, but also increase the cost of delivery of care, due to hospital readmissions, increased length of stay,[5,6] and operative revisions, such as removal of hardware in orthopedic surgery infections.[7] Up to 60% of SSIs are preventable and are penalized in the Value-Based Purchasing and Hospital-Acquired Condition Reduction Programs.[8]

Common SSI-Related Questions

What causes a surgical site infection (SSI)?

  • “Microbial contamination of the surgical site is a necessary precursor of SSI” (CDC Guideline for Prevention of SSI, 1999)

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How often do SSIs take place?

  • “SSIs complicated approximately 1.9% of surgical procedures in the U.S. between 2006 & 2009” (CDC Guideline for the Prevention of SSI, 2017)
  • “The incidence of SSI is 2% to 5% in patients undergoing inpatient surgery” (American College of Surgeons and Surgical Infection Society: Surgical Site Guidelines, 2016 Update)

 

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What are the risk factors for SSI?

  • Patient characteristics possibly associated with an increased risk of an SSI include coincident remote site infections or colonization, diabetes, cigarette smoking, systemic steroid use, obesity, extremes of age, poor nutritional status and perioperative transfusion of certain blood products (CDC Guideline for Prevention of SSI, 1999)

What interventions help prevent SSI?

  • Recommended interventions are numerous and usually grouped by the setting. For example, the CDC separates recommendations by Preoperative, Intraoperative, Postoperative incision care and Surveillance (CDC Guideline for Prevention of SSI, 1999)
  • Others guidelines with recommendations include…
    1. WHO Global Guidelines for the Prevention of Surgical Site Infection, 2016
    2. American College of Surgeons and Surgical Infection Society: Surgical Site Guidelines, 2016 Update
  • CDC Guideline for the Prevention of SSI, 2017
  1. WI Division of Public Health Supplemental Guidance for the Prevention of Surgical Site Infections: An Evidence-Based Perspective, January 2017; Revised August 2017

What are the classifications of SSI?

  • CDC Guideline for Prevention of SSI, 1999 – p.251 (image)
  • According to the definition provided by the CDC, SSIs are classified by depth and tissue spaces involved (American College of Surgeons and Surgical Infection Society: Surgical Site Guidelines, 2016 Update)

A Deeper Look at Surgical Site Infections

The National Healthcare Safety Network (NHSN) divides the types of surgical site infection (SSI) into three categories, based on the depth of the infection. A superficial incisional SSI is an infection that occurs within 30 days of an operative procedure, involves only the skin and subcutaneous tissues of the incision, and has at
least one of the following:

1. “Purulent drainage with or without laboratory confirmation, from the superficial incision.

2. Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision.

3. At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat and superficial incision is deliberately opened by surgeon, unless incision is culture negative.

4. Diagnosis of superficial incisional SSI made by a surgeon or attending physician.” [1]

The other two types of infection defined by the NHSN are deep incisional SSI and organ/space SSI.[1] The definition of deep incisional SSI adds a period of up to 90 days after the procedure and includes purulent wound drainage or spontaneous dehiscence or required intentional opening of the wound, constitutional symptoms or positive imaging (e.g. abscess) or diagnosis by other testing or diagnosis by the surgeon or attending physician.[1]

Organ/space SSI includes all of the above signs and/or symptoms for deep incisional infection, but includes infection of any tissue manipulated during surgery.[1] Despite improved practices in infection control, SSIs still cause morbidity, increased length of hospitalization, and mortality.[2] With a goal of containing rising medical care costs, the Centers for Medicare & Medicaid Services selected conditions that are reasonably preventable and are costly to manage. These conditions are not reimbursed by Medicare and include SSI following certain orthopedic procedures as well as other surgical procedures.[3]

National Healthcare Safety Network. (2013). Surgical Site Infection Surveillance (SSI). Available at: http://apic.org/resource_/
TinyMceFileManager/Academy/ASC_101_resources/Surveillance_NHSN/ASCA_NHSN_SSI_Surveillance_2013.pdf
2. Centers for Disease Control and Prevention. (2017). Procedure-Associated Module SSI. Available at: https://www.cdc.gov/nhsn/pdfs/
pscmanual/9pscssicurrent.pdf
3. Centers for Medicare & Medicaid Services. (2015). Hospital-Acquired Conditions. Available at: https://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html
4. Magill, S. S., Edwards, J. R., Bamberg, W., et al. (2014) Emerging Infections Program Healthcare-Associated Infections and Antimicrobial
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10.1056/NEJMoa1306801.
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mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol, 20(11), 725-730. doi:10.1086/501572
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arthroplasty: a case-control study. J Arthroplasty, 29(6), 1098-1100. doi:10.1016/j.arth.2013.11.012
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Update. J Am Coll Surg, 224(1), 59-74. doi:10.1016/j.jamcollsurg.2016.10.029
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