Surgical site infections
Surgical site infection is a type of healthcare-associated infection in which a wound infection occurs after an invasive (surgical) procedure.
Following the CDC criteria for SSI, the definition of surgical site infection is:
- Date of event occurs within 30 days after any operative procedure.
- It involves only the skin and subcutaneous tissue of the incision.
- The patient has at least one of the following:
- Purulent drainage from the superficial incision.
- Organism(s) identified from an aseptically-obtained specimen from the superficial incision or subcutaneous tissue
- Superficial incision that is deliberately opened by a surgeon,
- The patient has at least one of the following signs or symptoms: localized pain or tenderness; localized swelling; erythema; or heat.
4. Diagnosis of a superficial incisional SSI by a physician.
Characteristics of site surgical infection (I-SSI)
It is known that 105 bacteria in 1 g of tissue is sufficient to induce I-SSI. Incisional SSI (I-SSI) is still a frequent postoperative adverse event jeopardizing patient safety and increasing healthcare costs.
SSI leads to increased overall healthcare costs and is associated with a prolonged hospital stay, more complex wound care needs, more frequent visits to outpatient clinics, and higher rates of hospital readmission and morbidities.
SSI is associated with a mortality rate of 3%, and 75% of SSI-associated deaths are directly attributable to SSI.
Risk factors for I-SSI
There are independent risk factors for I-SSI, and intraoperative wound management is one of the most important to reduce them.
The following improve intraoperative wound management:
- Antibiotic prophylaxis.
- Skin preparation.
- Skin drape.
- Operative double gloving.
- Body temperature.
- Wound length.
- Subcutaneous lavage before closure.
- Subcutaneous drainage.
- Skin suture methods (subcuticular absorbable suture).
- Skin wound dressing.
Management of surgical wound
Conventional surgical drapes are commonly used by surgeons to limit the aseptic surgical area and to cover the freshly-made wound edges.
This non-fixed mechanical barrier may become dislodged or potentially contaminated. New devices have appeared to overcome this problem and for wound-edge isolation.
These new surgical devices are based on a non-adhesive plastic sheath attached to a single or double rubber ring that firmly secures the sheath to the wound edges. They also provide extra incision retraction, which reduces the need for mechanical retractors.
They are used to reduce wound edge contamination during abdominal procedures including contamination from the outside (clean surgery) and inside the peritoneal cavity (clean contaminated, contaminated and dirty).
Wound protector results
A recently conducted meta-analysis of RCTs evaluated whether various types of wound protectors can reduce the risk of SSI.
Using wound protectors, the risk of SSI was 0.55 times the pooled estimated risk of SSI in control groups (95% CI 0.31 to 0.98).
When analyzing the reduction of SSI based on the type of surgery, it is beneficial in reducing the SSI rate when compared to standard wound protection in clean contaminated (OR: 0.63; 95% CI: 0.4–0.99) and contaminated (OR: 0.31; 95% CI: 0.15–0.64) procedures.
In the dual-ring versus single-ring comparison, the pooled estimated risk of SSI was 0.31 (95% CI 0.14 to 0.67).
TAKE HOME MESSAGES
- SSI is still a frequent postoperative complication with significant overall healthcare costs and high rates of hospital readmission and morbidity.
- Intraoperative wound management is one of the most important factors to reduce SSI.
- Wound protectors have evolved to improve the limitations of the aseptic area and reduce SSI.
- Dual-ring wound protectors have shown better outcomes when compared with single-ring ones.
- The latest guidelines recommend the use of wound protectors for the prevention of SSI.