Surgical site infections and ‘the enemy within’

At a recent symposium on surgical site infection, hosted by Ethicon, experts gathered to discuss the risk factors and possible strategies to reduce this costly and distressing problem. Dr Neil Wigglesworth, nurse consultant, infection control, at Salford Royal NHS Foundation Trust, tackled the issue of risk management, providing an overview of key factors implicated in the prevalence of SSIs. He explained that the Harvard Medical Practice study examined 30,000 random patient records and found that the top three causes of adverse events were medication related (19%), wound infections (14%) and technical complications (13%). Over half of these adverse events were deemed preventable and all of these events led to disability or prolonged hospital stay. In addition, more than 13% died as a direct result. He outlined some of the patient factors that increase the risk of SSIs, including: age, underlying illness, diabetes, chemotherapy and radiotherapy, use of steroids, obesity or malnutrition, pre-existing remote infection or colonisation, smoking, the classification of wound and gender (there is more prevalence among male patients). Although subjective, the ASA Score is also highly predictive, he pointed out. Derived from the American Society of Anesthesiologists’ classification system of physical status, the system is used for assessing a patient prior to surgery. Patients with a high ASA score are more likely to suffer from SSI, Dr Wigglesworth explained, while further outlining the following risk factors:

Pre-operative risk factors

Pre-operative factors that influence risk include length of pre-op hospital stay – the longer the stay, the greater the risk. Emergency surgery and blood transfusions are also influential factors, he pointed out. He added that pre-op showering can help reduce the risk, while hair removal – if necessary – should be via clippers. It is important that the patient should not be shaved – whether this is by a healthcare professional or by the patient beforehand for cosmetic reasons. Effective skin preparation is another key issue, while appropriate use of antimicrobial prophylaxis is also important. Sterilisation of instruments is, of course, vital.