Dossier n. 261/2017 [Abstract] Prevention of surgical site infections

Key messages

• Surgical site infections (SSIs) occur in approximately 2% of surgical interventions; among all healthcare-associated infections, these infections have the greatest economic impact.
• A significant proportion of surgical site infections, up to 55% as estimated by several studies, can be prevented. Infection surveillance and control programs, conducted in single hospitals or as part of multicentre interventions, have demonstrated that a significant reduction of the risk of surgical site infections is possible by adopting measures supported by solid scientific evidence.
• A high variability among Emilia-Romagna healthcare structures is registered in SSI incidence. This is due to several factors such as characteristics of hospitalized patients, differences in identification criteria, organization of control measures (eg. hand hygiene), appropriateness of perioperative antibiotic prophylaxis, or the ability to monitor surgical site infections through surveillance systems.
• Main goals of this document are:
• To provide surgeons and surgical nurses, professionals responsible for control of healthcare-associated infection risk, medical staff, and Health managers with a synthetic but comprehensive picture of the measures that have to be applied to prevent surgical site infections;
• To recognize main obstacles to the application of these measures and to suggest tools and methods to overcome them;
• To identify and promote the use of indicators to monitor the implementation of these measures in Emilia-Romagna healthcare structures
• This document is based on the national Guidelines on prevention and control of healthcare-associated infections published in 2010, which included guidelines published up to 2008. For this update, a research of guidelines on surgical site infections prevention published since 2008 and of systematic reviews was carried out.
• Surgical infections prevention – as a key element for assuring safe surgery - must be a key objective for healthcare professionals and for managers in public and private hospitals in Emilia-Romagna. It is therefore essential to widely use this document:
• To review practices in use and evaluate how far they deviate from those supported by strong scientific evidence, that are described in the document;
• To identify corrective actions and implement them, monitoring over time whether adherence to recommended measures is actually increased and if it has a positive impact on the incidence of surgical infections;
• To adopt a multi-modal approach to surgical infection control (bundle), through the implementation of programs aimed at adopting 3-6 key measures and the constant monitoring of adherence to these measures.
• To demonstrate a measurable improvement in the quality of care provided, healthcare structures and all hospitals that carry out surgical activities must participate in the Emilia-Romagna regional surveillance system. Moreover, the implementation of improvement actions has to be monitored through the process indicators recommended in this document.