Surgical site infections in the Hospital patients - Guidelines can prevent them?
American Journal of Surgery - Volume 201, Issue 1 (January 2011)
Surgical site infections (SSIs) occur in more than 500,000 patients annually and result in increased length of hospital stay, readmissions, costs, and mortality in USA. [1] , [2] Up to 60% of SSIs have been estimated to be preventable, [3] , [4] , [5] largely by using recommended evidence-based guidelines such as timely and appropriate administration of antibiotics for prophylaxis and maintenance of perioperative normothermia. [3] , [6] , [7] , [8] A number of hospitals have reported decreased infection rates by improving utilization of these guidelines. [9] , [10] Furthermore, lack of compliance with these guidelines is associated with a significant increase in mortality.[11] Despite the evidence that these measures improve outcome, compliance with these guidelines is suboptimal in many hospitals, as demonstrated by data from large administrative databases and cohort studies. [9] , [12] , [13] , [14] Bratzler et al evaluated a random sample of 34,133 Medicare patients and found that only 56% of patients received antimicrobial therapy within 1 hour before incision and that only 40% had appropriate discontinuation of prophylactic antibiotics after 24 hours.[13] Based on poor compliance with these guidelines and the high morbidity and mortality of postoperative complications, the Surgical Care Improvement Project (SCIP) was developed as a collaborative effort to prevent infectious, thromboembolic, cardiac, and respiratory complications.[15]
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3 Mangram A.J., Horan T.C., Pearson M.L., et al: Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory CommitteeAm J Infect Control 27. 97-132.1999; Full Text
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7 Horan T.C., Gaynes R.P., Martone W.J., et al: CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13. 606-608.1992; Citation
8 Kurz A., Sessler D.I., Lenhardt R.: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature GroupN Engl J Med 334. 1209-1215.1996; Abstract
9 Dellinger E.P., Hausmann S.M., Bratzler D.W., et al: Hospitals collaborate to decrease surgical site infections. Am J Surg 190. 9-15.2005; Full Text
10 Hedrick T.L., Heckman J.A., Smith R.L., et al: Efficacy of protocol implementation on incidence of wound infection in colorectal operations. J Am Coll Surg 205. 432-438.2007; Full Text
11 Mahid S.S., Polk , Jr , JrH.C., Lewis J.N., et al: Opportunities for improved performance in surgical specialty practice. Ann Surg 247. 380-388.2008; Abstract
12 Bratzler D.W., Houck P.M.: Antimicrobial prophylaxis for surgery: an advisory statement from the national surgical infection prevention project. Clin Infect Dis 38. 1706-1715.2004; Abstract
13 Bratzler D.W., Houck P.M., Richards C., et al: Use of antimicrobial prophylaxis for major surgery: baseline results from the national surgical infection prevention project. Arch Surg 140. 174-182.2005; Abstract
14 Silver A., Eichorn A., Kral J., et al: Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. The Antibiotic Prophylaxis Study GroupAm J Surg 171. 548-552.1996; Abstract
15 Bratzler D.W., Hunt D.R.: The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 43. 322-330.2006; Abstract
