A 2015 survey by the Centers for Disease Control and Prevention found that there were an estimated 110,800 surgical site infections from inpatient surgeries alone that year. Despite improvements made in infection control practices over the past few decades, surgical site infections remain a substantial cause of morbidity, prolonged hospital stay, and mortality for surgical patients. Surgical site infections are associated with a two to eleven fold increase in the risk of mortality, and 75% of deaths associated with these infections can be directly attributed to the infection caused by surgery. Further, among infections acquired in healthcare settings, those associated with surgical procedures are frequently the most expensive. In order to prevent potentially distressing, harmful, and expensive post-operative complications for patients, it is critical that OR teams follow strict infection control procedures before, during, and after surgery.1
A surgical site infection typically occurs within 30 days of the surgery. There are three different types of surgical site infections recognized by the CDC: superficial incisional infections (occurring just in the area of the skin where the incision was made), deep incisional infections (occurring beneath the incision area in the muscles and tissue surrounding the incision), and organ or space infections (occurring in any part other than the skin, tissues, or muscles involved in the surgery). Some symptoms that a surgical site infection has occurred include redness, delayed healing, fever, pain, tenderness, warmth, swelling, and the production of pus (samples of which may be used by a physician to identify the pathogens causing the infection and which, in organ or space infections, can create an abscess). Although most surgical site infections can be treated with antibiotics, it is sometimes necessary to perform additional procedures (including surgical procedures) to treat these infections.2 It is far preferable to prevent surgical site infections altogether.
There is an urgent need for stringent protocols to be established around infection control for surgery, especially in countries that lack adequate resources for infection prevention. Many medical organizations have established guidelines, including the World Health Organization’s ten essential objectives for safe surgery and surgical safety checklist. Infection control also relates to environmental control and design of the operating theater to ensure proper ventilation and aseptic conditions, instrument decontamination and sterilization, and operating room decorum (including gloving and degloving technique, steps of donning a surgical gown, and others).
Identifying patient risk factors is another important component of infection control for surgery. For example, malnutrition and obesity and pre- and intraoperative factors such as the removal of hair and an extended duration for the procedure increase risk.3
Seidelman et al. reviewed the available research around strategies for preventing surgical site infections. Identified strategies include avoiding using razors for hair removal, maintaining a
normal temperature during the surgical procedure, using chlorhexidine gluconate plus alcohol-based skin preparation agents, decolonization with antistaphylococcal intranasal agents and skin antiseptics for high-risk procedures, controlling for glucose concentrations during the operation, and using negative pressure wound therapy.4
Clinicians can utilize existing research and guidelines to control infection risk during surgery. Continued research into infection control techniques, as well as the continued normalization and implementation of these techniques, will help physicians keep improving the safety of surgical procedures into the future.
References
(1) Surgical Site Infection. 2024.
(2) Surgical Site Infections | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections.
(3) Bali, R. K. Operating Room Protocols and Infection Control. In Oral and Maxillofacial Surgery for the Clinician; Bonanthaya, K., Panneerselvam, E., Manuel, S., Kumar, V. V., Rai, A., Eds.; Springer Nature Singapore: Singapore, 2021; pp 173–194. https://doi.org/10.1007/978-981-15-1346-6_9.
(4) Seidelman, J. L.; Mantyh, C. R.; Anderson, D. J. Surgical Site Infection Prevention: A Review. JAMA 2023, 329 (3), 244. https://doi.org/10.1001/jama.2022.24075.