Back to Basics: Preventing Surgical Site Infections

Abstract

A surgical site infection (SSI) is an unintended and oftentimes preventable consequence of surgery. There is a significant amount of literature related to preventing SSIs, and it is up to practitioners in each care setting to review the evidence and work together to implement SSI prevention measures, such as nasal decolonization, antibiotic prophylaxis, preoperative showers, preoperative oxygen supplementation, and antimicrobial sutures. In addition, practitioners can follow several recommendations to reduce the risk of SSIs, including following proper hand hygiene practices; wearing clean, facility-laundered scrub attire; following a surgical safety checklist; and speaking up when a break in sterile technique is witnessed. The benefits of preventing SSIs are preventing patient mortality and decreasing the burden that SSIs pose on the national health care system. It is up to health care leaders to drive and support SSI prevention initiatives.

Evaluation of adherence to measures for the prevention of surgical site infections by the surgical team

“…In regard to this practice, some patients took a shower in the morning of the surgery without using an antiseptic soap. This subject is controversial among manuals and guidelines that address the issue because although some antiseptic agents are able to significantly reduce microorganisms on intact skin and have a wide spectrum of activity, and fast, persistent and cumulative action, there is not sufficient scientific evidence to demonstrate the reduction of the SSI rate after a preoperative bath (6)(7)(8)(12)(13)(14) . Bathing with an antiseptic at least one night before surgery has been referenced in various global guidelines, recommended since the CDC guideline of 1999, which is for many their current important guideline reference (6,12,15) .…”

“…As for attire, the recommendation for the surgical team wearing gowns, sterile surgical gloves, masks and caps covering their hair during surgery is well-established (1,6,(14)(15)(16) . Although microorganisms coming from the skin, mucosa and hair of the surgical team is a proven fact, there is no evidence demonstrating the relationship between the use of attire and reducing the incidence of SSI (1,(14)(15) .…”

“…Although microorganisms coming from the skin, mucosa and hair of the surgical team is a proven fact, there is no evidence demonstrating the relationship between the use of attire and reducing the incidence of SSI (1,(14)(15) . However, the use of these protective barriers seem to minimize patient exposure to microorganisms from the surgical team and vice versa (1,15) .…”

“…With regard to the removal of hair, the recommendation in accordance with national and international guidelines is that the hair is not removed unless it interferes with the surgery. In cases of removal, it is recommended to use electric clippers immediately before surgery (1,6,(12)(13)(14) . Preoperative bathing is aimed at removing dirt and part of the microbiota on the patient's epidermis/skin.…”

“…The surgical antibiotic prophylaxis is one of the most important methods available for preventing SSI (3,7) . It aims at reducing the concentration of potential pathogens in the incision area, contributing to significant reductions in infection rates (3,(14)(15) . Regarding the use of registered antimicrobial prophylaxis, most (78.6%) were appropriately prescribed as the protocol of the institution, and some (21.4%) were suitable to replace the drug of choice in accordance with local protocol, being however also considered able to cover the microorganisms of the surgical area involved, thereby being a satisfactory choice in their spectrum of action.…”