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Surgical Site Infections (SSIs): Risk Factors and Prevention Strategies

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European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 13))

Abstract

Surgical site infections (SSIs) occur in about 1.5 % of Orthopaedic procedures. They are associated with high morbidity and mortality. Risk factors of SSIs have been extensively investigated. Roughly, the risk factors can be divided into: patient-related, surgical procedures -related and operating room environment-related. Patient-related factors are, for example: age, severity of illness, diabetes, obesity, mal-nutrition, smoking, and using of immunosuppressive medications. Surgical procedures-related factors are related to the preparation of the patient and surgical team before the incision, and with surgical duration and techniques. The ventilation and laminar flow in the operating room might also have a role in SSIs. Lastly, the use of peri-operative antibiotic prophylaxis will also influence the risk of having SSIs.

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References

  1. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278

    Article  PubMed  CAS  Google Scholar 

  2. Pittet D, Harbarth S, Ruef C et al (1999) Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland. Infect Control Hosp Epidemiol 20:37–42

    Article  PubMed  CAS  Google Scholar 

  3. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB (2009) Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 37:387–397

    Article  PubMed  Google Scholar 

  4. Astagneau P, Rioux C, Golliot F, Brucker G (2001) Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect 48:267–274

    Article  PubMed  CAS  Google Scholar 

  5. Emori TG, Gaynes RP (1993) An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 6:428–442

    PubMed  CAS  Google Scholar 

  6. Weigelt JA, Lipsky BA, Tabak YP, Derby KG, Kim M, Gupta V (2010) Surgical site infections: causative pathogens and associated outcomes. Am J Infect Control 38:112–120

    Article  PubMed  Google Scholar 

  7. Anderson DJ, Kaye KS, Classen D et al (2008) Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 29(Suppl 1):S51–S61

    Article  PubMed  Google Scholar 

  8. Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH (1993) Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 128:79–88

    Article  PubMed  CAS  Google Scholar 

  9. Jamsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T (2012) Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am 94:e1011–e1019

    Google Scholar 

  10. Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA (2006) Long-term glycemic control and postoperative infectious complications. Arch Surg 141:375–380

    Article  PubMed  Google Scholar 

  11. Alexander JW, Solomkin JS, Edwards MJ (2011) Updated recommendations for control of surgical site infections. Ann Surg 253:1082–1093

    Article  PubMed  Google Scholar 

  12. Hugonnet S, Pittet D (2000) Hand hygiene-beliefs or science? Clin Microbiol Infect 6:350–356

    Article  PubMed  CAS  Google Scholar 

  13. Wihlborg O (1987) The effect of washing with chlorhexidine soap on wound infection rate in general surgery. A controlled clinical study. Ann Chir Gynaecol 76(5):263–265

    PubMed  CAS  Google Scholar 

  14. Webster J, Osborne S (2006) Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. (2):CD004985

    Google Scholar 

  15. Edmiston CE Jr, Krepel CJ, Seabrook GR, Lewis BD, Brown KR, Towne JB (2008) Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission? J Am Coll Surg 207:233–239

    Article  PubMed  Google Scholar 

  16. Perl TM, Cullen JJ, Wenzel RP et al (2002) Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 346:1871–1877

    Article  PubMed  CAS  Google Scholar 

  17. van Rijen MM, Bonten M, Wenzel RP, Kluytmans JA (2008) Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. J Antimicrob Chemother 61:254–261

    Article  PubMed  Google Scholar 

  18. Jones JC, Rogers TJ, Brookmeyer P et al (2007) Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin Infect Dis 45:541–547

    Article  PubMed  CAS  Google Scholar 

  19. Tanner J, Norrie P, Melen K (2011) Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev (2);CD004122

    Google Scholar 

  20. Association of Operating Room Nurses (1996) Recommended practices for skin preparation of patients. (abstract) Association of Operating Room Nurses. AORN J 64:813–816

    Article  Google Scholar 

  21. Tschudin-Sutter S, Frei R, Egli-Gany D et al (2012) No risk of surgical site infections from residual bacteria after disinfection with povidone-iodine-alcohol in 1014 cases: a prospective observational study. Ann Surg 255:565–569

    Article  PubMed  Google Scholar 

  22. Drosou A, Falabella A, Kirsner R (2012) Antiseptics on wounds: an area of controversy. Wounds 15(5):149–166

    Google Scholar 

  23. Edwards PS, Lipp A, Holmes A (2004) Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev (3):CD003949

    Google Scholar 

  24. Darouiche RO, Wall MJ, Jr., Itani KM, et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. The New England journal of medicine. 2010;362(1):18–26.

    Google Scholar 

  25. Werner H (2001) Qualität von OP-Abdeckmaterial und OP-Mäntel. Hyg Med 26:62–75

    Google Scholar 

  26. American Society for Testing Materials (1998) Standard test method for resistance of materials used in protective clothing to penetration by synthetic blood. [abstract] American Society for Testing Materials. ASTM. F1670–1698

    Google Scholar 

  27. Garibaldi RA, Maglio S, Lerer T, Becker D, Lyons R (1986) Comparison of nonwoven and woven gown and drape fabric to prevent intraoperative wound contamination and postoperative infection. Am J Surg 152:505–509

    Article  PubMed  CAS  Google Scholar 

  28. French ML, Eitzen HE, Ritter MA (1976) The plastic surgical adhesive drape: an evaluation of its efficacy as a microbial barrier. Ann Surg 184:46–50

    Article  PubMed  CAS  Google Scholar 

  29. Webster J, Alghamdi AA (2007) Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev (4):CD006353

    Google Scholar 

  30. Jacobson C, Osmon DR, Hanssen A et al (2005) Prevention of wound contamination using DuraPrep solution plus Ioban 2 drapes. Clin Orthop Relat Res 439:32–37

    Article  PubMed  Google Scholar 

  31. National Collaborating Centre for Womens and Childrens Health (2008) Surgical site infection prevention and treatment of surgical site infection. Ref type: Report

    Google Scholar 

  32. Centers for Disease Control and Prevention (2002) Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA HandHygiene Task Force. Ref type: Report

    Google Scholar 

  33. Jarral OA, McCormack DJ, Ibrahim S et al. Should surgeons scrub with chlorhexidine or iodine prior to surgery? Interactive cardiovascular and thoracic surgery. 2011;12(6):1017–21. Epub 2011/03/03.

    Google Scholar 

  34. Hingst V, Juditzki I, Heeg P, Sonntag HG (1992) Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 min. J Hosp Infect 20:79–86

    Article  PubMed  CAS  Google Scholar 

  35. Chen CF, Han CL, Kan CP, Chen SG, Hung PW (2012) Effect of surgical site infections with waterless and traditional hand scrubbing protocols on bacterial growth. Am J Infect Control 40:e15–e17

    Article  PubMed  Google Scholar 

  36. Duguid JP, Wallace AT (1948) Air infection with dust liberated from clothing. Lancet 2:845–849

    Article  PubMed  CAS  Google Scholar 

  37. Braswell ML, Spruce L (2012) Implementing AORN recommended practices for surgical attire. AORN J 95:122–137

    Article  PubMed  Google Scholar 

  38. Mitchell NJ, Hunt S (1991) Surgical face masks in modern operating rooms – a costly and unnecessary ritual? J Hosp Infect 18:239–242

    Article  PubMed  CAS  Google Scholar 

  39. Misteli H, Weber WP, Reck S et al (2009) Surgical glove perforation and the risk of surgical site infection. Arch Surg 144:553–558

    Article  PubMed  Google Scholar 

  40. Laine T, Aarnio P (2001) How often does glove perforation occur in surgery? Comparison between single gloves and a double-gloving system. Am J Surg 181:564–566

    Article  PubMed  CAS  Google Scholar 

  41. Leong G, Wilson J, Charlett A (2006) Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect 63:255–262

    Article  PubMed  CAS  Google Scholar 

  42. Peersman G, Laskin R, Davis J, Peterson MG, Richart T (2006) Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2:70–72

    Article  PubMed  CAS  Google Scholar 

  43. McHugh SM, Hill AD, Humphreys H (2011) Intraoperative technique as a factor in the prevention of surgical site infection. J Hosp Infect 78:1–4

    Article  PubMed  CAS  Google Scholar 

  44. Tajirian AL, Goldberg DJ (2010) A review of sutures and other skin closure materials. J Cosmet Laser Ther 12:296–302

    Article  PubMed  Google Scholar 

  45. Gabrielli F, Potenza C, Puddu P, Sera F, Masini C, Abeni D (2001) Suture materials and other factors associated with tissue reactivity, infection, and wound dehiscence among plastic surgery outpatients. Plast Reconstr Surg 107:38–45

    Article  PubMed  CAS  Google Scholar 

  46. Hochberg J, Meyer KM, Marion MD (2009) Suture choice and other methods of skin closure. Surg Clin North Am 89:627–641

    Article  PubMed  Google Scholar 

  47. Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86-A:1146–1152

    PubMed  Google Scholar 

  48. Clifton R, Haleem S, McKee A, Parker MJ (2008) Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials. Int Orthop 32:723–727

    Article  PubMed  CAS  Google Scholar 

  49. Clifton R, Haleem S, McKee A, Parker MJ (2007) Closed suction surgical wound drainage after anterior cruciate ligament reconstruction: a systematic review of randomised controlled trials. Knee 14:348–351

    Article  PubMed  CAS  Google Scholar 

  50. Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334:1209–1215

    Article  PubMed  CAS  Google Scholar 

  51. Greif R, Sessler DI (2004) Supplemental oxygen and risk of surgical site infection. JAMA 291:1957–1959

    Article  PubMed  CAS  Google Scholar 

  52. Kabon B, Akca O, Taguchi A et al (2005) Supplemental intravenous crystalloid administration does not reduce the risk of surgical wound infection. Anesth Analg 101:1546–1553

    Article  PubMed  CAS  Google Scholar 

  53. Friberg B (1998) Ultraclean laminar airflow ORs. AORN J 67:841–851

    Article  PubMed  CAS  Google Scholar 

  54. Lidwell OM (1986) Clean air at operation and subsequent sepsis in the joint. Clin Orthop Relat Res (211):91–102

    Google Scholar 

  55. Anderson D, Sexton D (2012) Controversies in control measures to prevent surgical site infection. www.uptodate.com. Accessed on Sep 13, 2012

  56. Brandt C, Hott U, Sohr D, Daschner F, Gastmeier P, Ruden H (2008) Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 248:695–700

    Article  PubMed  Google Scholar 

  57. Lynch RJ, Englesbe MJ, Sturm L et al (2009) Measurement of foot traffic in the operating room: implications for infection control. Am J Med Qual 24:45–52

    Article  PubMed  Google Scholar 

  58. Ayliffe GA (1991) Role of the environment of the operating suite in surgical wound infection. Rev Infect Dis 13(Suppl 10):S800–S804

    Article  PubMed  Google Scholar 

  59. American Academy of Orthopedic Surgeons (2004) Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty. Ref type: Unenacted Bill/Resolution

    Google Scholar 

  60. Bratzler DW (2001) Osteopathic manipulative treatment and outcomes for pneumonia. J Am Osteopath Assoc 101:427–428

    PubMed  CAS  Google Scholar 

  61. Kalman D, Barriere SL (1990) Review of the ­pharmacology, pharmacokinetics, and clinical use of cephalosporins. Tex Heart Inst J 17:203–215

    Article  PubMed  CAS  Google Scholar 

  62. Koch CG, Nowicki ER, Rajeswaran J, Gordon SM, Sabik JF III, Blackstone EH (2012) When the timing is right: antibiotic timing and infection after cardiac surgery. J Thorac Cardiovasc Surg 144(4):931–937

    Article  PubMed  Google Scholar 

  63. French GL (1998) Enterococci and vancomycin resistance. Clin Infect Dis 27(Suppl 1):S75–S83

    Article  PubMed  CAS  Google Scholar 

  64. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326:281–286

    Article  PubMed  CAS  Google Scholar 

  65. Weber WP, Marti WR, Zwahlen M et al (2008) The timing of surgical antimicrobial prophylaxis. Ann Surg 247:918–926

    Article  PubMed  Google Scholar 

  66. American Society of Health-System Pharmacists (1999) ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 56:1839–1888

    Google Scholar 

  67. Dettenkofer M, Forster DH, Ebner W, Gastmeier P, Ruden H, Daschner FD (2002) The practice of perioperative antibiotic prophylaxis in eight German hospitals. Infection 30:164–167

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Septic Surgical Unit, Department of Surgery and Anaesthesiology, Lausanne University Hospital, BH-10 Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Olivier Borens

  2. Infectious Diseases Service, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Erlangga Yusuf

  3. Center for Musculoskeletal Surgery, Charité, University Medicine, Free and Humboldt-University of Berlin, Chariteplatz 1, D-10117, Berlin, Germany

    Andrej Trampuz

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  1. Olivier Borens
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  2. Erlangga Yusuf
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  3. Andrej Trampuz
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Correspondence to Olivier Borens .

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Editors and Affiliations

  1. Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, Middlesex, United Kingdom

    George Bentley

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Borens, O., Yusuf, E., Trampuz, A. (2013). Surgical Site Infections (SSIs): Risk Factors and Prevention Strategies. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 13. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36149-4_2

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  • DOI: https://doi.org/10.1007/978-3-642-36149-4_2

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