Upon completion of the chapter, the reader will be able to:
Describe the impact of surgical site infections (SSIs) on patient outcomes and health care costs.
Name and differentiate the four different types of wound classifications.
Recognize at least three risk factors for postoperative SSIs.
Identify likely pathogens associated with different surgical operations.
Compare and contrast antimicrobials used for surgical prophylaxis and identify potential advantage and disadvantages for each antimicrobial.
Discuss the importance of β-lactam allergy screening and how this could impact resistance and health care costs.
Identify nonantimicrobial methods that can reduce the risk of postoperative infection.
Discuss the importance of antimicrobial timing, duration, and redosing in relation to antimicrobial prophylaxis in surgery.
Recommend appropriate prophylactic antimicrobial(s) given a surgical operation.
KEY CONCEPT Surgical site infections (SSIs) are a significant cause of morbidity and mortality. Approximately 2% to 5% of patients undergoing clean extra-abdominal operations and 20% undergoing intra-abdominal operations will develop an SSI.1 SSIs have become the second most common cause of nosocomial infection, and these data are likely underestimated due to a large number of surgical procedures being performed on an outpatient basis.1,2
SSIs negatively affect patient outcomes and increase health care costs. Patients who develop SSIs are five times more likely to be readmitted to the hospital and have twice the mortality of patients who do not develop an SSI.1 A patient with an SSI is also 60% more likely to be admitted to an ICU.1 SSIs lengthen hospital stays and increase costs.1,3,4 Deep SSIs, involving organs or spaces, result in longer durations of hospital stay and higher costs compared with incisional SSIs.5 Additionally, since 2008, Medicare and Medicaid Services no longer reimburses hospitals for any cost incurred from treating certain hospital-acquired infections, including SSIs.6
SSIs are defined and reported according to Centers for Disease Control and Prevention (CDC) criteria.5 SSIs are classified as either incisional or organ/space. Incisional SSIs are further divided into superficial incisional SSI (skin or subcutaneous tissue) and deep incisional SSI (deeper soft tissues of the incision). Organ/space SSIs involve any anatomic site other than the incised areas (eg, meningitis after brain tumor removal). An infection is considered an SSI if any of the above criteria is met and the infection occurs within 30 days of the operation. If a prosthetic is implanted during the operation, the timeline extends out to 1 year.
EPIDEMIOLOGY AND ETIOLOGY
Risk factors for SSIs can be divided into two categories: patient and operative characteristics.5,7,8 Patient risk factors for SSI include age, comorbid disease states (especially chronic lung disease and diabetes), malnutrition, immunosuppression, nicotine or steroid use, and colonization of the nares with Staphylococcus aureus. Modifying risk factors prior to planned operations may decrease ...