Strategies to Prevent Surgical Site Infections in Acute Care Hospitals

Abstract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals to implement and prioritize their surgical site infection (SSI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.

1. Burden of SSIs as complications in acute care facilities.

a. SSIs occur in 2%-5% of patients undergoing inpatient surgery in the United States.

b. Approximately 500,000 SSIs occur each year.

2. Outcomes associated with SSI

a. Each SSI is associated with approximately 7-10 additional postoperative hospital days.

b. Patients with an SSI have a 2-11 times higher risk of death, compared with operative patients without an SSI.

i. Seventy-seven percent of deaths among patients with SSI are direcdy attributable to SSI.

c. Attributable costs of SSI vary, depending on the type of operative procedure and the type of infecting pathogen; published estimates range from $3,000 to $29,000.

i. SSIs are believed to account for up to $10 billion annually in healthcare expenditures.

1. Definitions

a. The Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System and the National Healthcare Safety Network definitions for SSI are widely used.

b. SSIs are classified as follows (Figure):

i. Superficial incisional (involving only skin or subcutaneous tissue of the incision)

ii. Deep incisional (involving fascia and/or muscular layers)

iii. Organ/space