Optimisation of perioperative procedural factors to reduce the risk of surgical site infection in patients undergoing surgery: a systematic review

Abstract

Surgical site infections (SSI) are the leading cause of hospital readmission after surgical procedures with significant impact on post-operative morbidity and mortality. Modifiable risk factors for SSI include procedural aspects, which include the possibility of instrument contamination, the duration of the operation, the number of people present and the traffic in the room and the ventilation system of the operating theatre.The aim of this systematic review was to provide literature evidence on the relationship between features of surgical procedure sets and the frequency of SSI in patients undergoing surgical treatment, and to analyse how time frames of perioperative processes and operating theatre traffic vary in relation to the features of the procedure sets use, in order tooptimise infection control in OT. The results of the systematic review brought to light observational studies that can be divided into two categories: evidence of purely clinical significance and evidence of mainly organisational, managerial and financial significance. These two systems are largely interconnected, and reciprocally influence each other. The decision to use disposable devices and instruments has been accompanied by a lower incidence in surgical site infections and surgical revisions for remediation. A concomitant reduction in post-operative functional recovery time has also been observed. Also, the rationalisation of traditional surgical sets has also been observed in conjunction with outcomes of clinical significance.

Guidelines for improvement of the procedural aspects of devices and surgical instruments in the operating theatre

“…Nevertheless, procedural optimization appears to be a feasible way of addressing modifiable risk factors. Perioperative process times and operating theatre traffic can be affected by the procedure sets involved ( 4 , 9 ) and can be addressed through set streamlining.A wide part of our guidelines regards the optimization of surgical instrumentation. The literature review purposefully considered many quality improvement reportsto catch the features that future programs should showcase.…”

“…A systematic literature review ( 9 ) was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses—PRISMA Statement 2020 ( 11 ) on the use and streamlining of disposable surgical procedure sets. The review was conducted blindly between authors and reviewers.…”

“…The structure and contents of this document derive from the work of the Advisory Board and an in-depth systematic literature review ( 9 ) and are written in accordance with the AGREE-IIChecklist ( 10 ).…”