SSIs are among the most common healthcare-associated infections (HAIs), accounting for up to 21.8% of HAIs according to a study by Magill et al.[4] SSIs not only cause increased morbidity and mortality for patients, but also increase the cost of delivery of care, due to hospital readmissions, increased length of stay,[5,6] and operative revisions, such as removal of hardware in orthopedic surgery infections.[7] Up to 60% of SSIs are preventable and are penalized in the Value-Based Purchasing and Hospital-Acquired Condition Reduction Programs.[8]
The National Healthcare Safety Network (NHSN) divides the types of surgical site infection (SSI) into three categories, based on the depth of the infection. A superficial incisional SSI is an infection that occurs within 30 days of an operative procedure, involves only the skin and subcutaneous tissues of the incision, and has at
least one of the following:
1. “Purulent drainage with or without laboratory confirmation, from the superficial incision.
2. Organisms isolated from an aseptically obtained culture of fluid or tissue from the superficial incision.
3. At least one of the following signs or symptoms of infection: pain or tenderness, localized swelling, redness, or heat and superficial incision is deliberately opened by surgeon, unless incision is culture negative.
4. Diagnosis of superficial incisional SSI made by a surgeon or attending physician.” [1]
The other two types of infection defined by the NHSN are deep incisional SSI and organ/space SSI.[1] The definition of deep incisional SSI adds a period of up to 90 days after the procedure and includes purulent wound drainage or spontaneous dehiscence or required intentional opening of the wound, constitutional symptoms or positive imaging (e.g. abscess) or diagnosis by other testing or diagnosis by the surgeon or attending physician.[1]
Organ/space SSI includes all of the above signs and/or symptoms for deep incisional infection, but includes infection of any tissue manipulated during surgery.[1] Despite improved practices in infection control, SSIs still cause morbidity, increased length of hospitalization, and mortality.[2] With a goal of containing rising medical care costs, the Centers for Medicare & Medicaid Services selected conditions that are reasonably preventable and are costly to manage. These conditions are not reimbursed by Medicare and include SSI following certain orthopedic procedures as well as other surgical procedures.[3]
Study Design and Measures of Patient Satisfaction In the study “Antimicrobial Dressing versus Standard Dressing in Obese Women Undergoing Cesarean Delivery: A Randomized Controlled Trial” conducted by Dr. Antonio Saad and colleagues at the University of Texas Medical Branch, ReliaTect antimicrobial dressing was compared to standard wound dressing. It is the first published trial comparing…
Surgical site infection (SSI) occurs in 2-5% of all surgeries which correlates to about 157,5000 SSIs in the U.S. on a yearly basis.1 Not only do SSIs impact patient outcomes and mortality rates, but also satisfaction scores and budgets of medical institutions. In the webinar, Reducing Surgical Site Infections: Surgical Stewardship, Maureen P. Spencer discusses…
Back-to-Basics Approach for Improving Surgical Outcomes 3 Questions With… features some of the finest thought leaders in healthcare specialties such as Infection Prevention, Vascular Access, Surgical Care and more. These experts answer questions on the latest insights, evidence and current practices. For our newest 3 Questions With… Eloquest Healthcare is proud to feature Peter Graves, BSN, RN,…
Expert Recommendations on Improving Surgical Care 3 Questions With… features some of the finest thought leaders in healthcare specialties such as Infection Prevention, Vascular Access, Surgical Care and more. These experts answer questions on the latest insights, evidence and current practices. For our newest 3 Questions With… Eloquest Healthcare is proud to feature Maureen Spencer, RN, M.Ed.,…
Eloquest Healthcare is excited to feature Gwen Borlaug, MPH, CIC, FAPIC! Gwen worked at the Wisconsin Division of Public Health (DPH) as the Director of the Healthcare-Associated Infection Prevention Program and as an infection prevention epidemiologist. She launched a statewide public health initiative to reduce surgical site infections, using a surgical care champion to provide peer-to-peer…
Our newest edition of 3 Questions With… 3 Questions With… features some of the finest thought leaders in healthcare specialties such as Infection Prevention, Vascular Access, Surgical Care and more. These experts answer questions on the latest insights, evidence and current practices. For our newest 3 Questions With… Eloquest Healthcare is proud to feature Gwen…
National Healthcare Safety Network. (2013). Surgical Site Infection Surveillance (SSI). Available at: http://apic.org/resource_/
TinyMceFileManager/Academy/ASC_101_resources/Surveillance_NHSN/ASCA_NHSN_SSI_Surveillance_2013.pdf
2. Centers for Disease Control and Prevention. (2017). Procedure-Associated Module SSI. Available at: https://www.cdc.gov/nhsn/pdfs/
pscmanual/9pscssicurrent.pdf
3. Centers for Medicare & Medicaid Services. (2015). Hospital-Acquired Conditions. Available at: https://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html
4. Magill, S. S., Edwards, J. R., Bamberg, W., et al. (2014) Emerging Infections Program Healthcare-Associated Infections and Antimicrobial
Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med, 370(13), 1198-1208. doi:
10.1056/NEJMoa1306801.
5. Kirkland, K. B., Briggs, J. P., Trivette, S. L., Wilkinson, W. E., & Sexton, D. J. (1999). The impact of surgical-site infections in the 1990s: attributable
mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol, 20(11), 725-730. doi:10.1086/501572
6. Digiovine, B., Chenoweth, C., Watts, C., & Higgins, M. (1999). The attributable mortality and costs of primary nosocomial bloodstream infections
in the intensive care unit. Am J Respir Crit Care Med, 160(3), 976-981. doi:10.1164/ajrccm.160.3.9808145
7. Cai, J., Karam, J. A., Parvizi, J., Smith, E. B., & Sharkey, P. F. (2014). Aquacel surgical dressing reduces the rate of acute PJI following total joint
arthroplasty: a case-control study. J Arthroplasty, 29(6), 1098-1100. doi:10.1016/j.arth.2013.11.012
8. Ban, K. A., Minei, J. P., Laronga, C., et al. (2017). American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016
Update. J Am Coll Surg, 224(1), 59-74. doi:10.1016/j.jamcollsurg.2016.10.029
9. Hospital Value-Based Purchasing. Department of Health and Human Services, Centers for Medicare & Medicaid Services. https://www.cms.gov/
Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf. Published
April 18, 2016. Accessed January 16, 2017.
10. FY 2017 HACRP Key Dates Matrix. Hospital-Acquired Condition Reduction Program (HACRP). Centers for Medicare & Medicaid Services. https://www.
cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Accessed January 16, 2017.
11. Office of Disease Prevention and Health Promotion. Health care quality and patient safety overview. Available at: https://health.gov/hcq/prevent-hai.asp
12. Green, S. A., & Ripley, M. J. (1984). Chronic osteomyelitis in pin tracks. J Bone Joint Surg Am, 66(7), 1092-1098.
13. Lethaby, A., Temple, J., & Santy-Tomlinson, J. (2013). Pin site care for preventing infections associated with external bone fixators and pins.
Cochrane Database Syst Rev, 12, CD004551. doi:10.1002/14651858.CD004551.pub3
14. Kwiatt, M., Tarbox, A., Seamon, M. J., et al. (2014). Thoracostomy tubes: a comprehensive review of complications and related topics. Int J Crit Illn Inj Sci,
4(2), 143-155. doi:10.4103/2229-5151.134182
15. Eren, S., Esme, H., Sehitogullari, A., & Durkan, A. (2008). The risk factors and management of posttraumatic empyema in trauma patients. Injury,
39(1), 44-49. doi:10.1016/j.injury.2007.06.001
Eloquest Healthcare, Inc. 7
16. Arom, K.V., Grover, F.L., Richardson, J.D., Trinkle, J.K. (1977). Post-traumatic empyema. Ann Thorac Surg, (23)3, 254-58.
17. Caplan E.S., Hoyt, N.J., Rodriguez, A., Cowley, R.A. (1984). Empyema occurring in the multiply injured traumatized patient. J Trauma, 24(9), 785-789.
18. Coselli, J.S., Mattox K.L., Beall, Jr., A.C. (1984). Reevaluation of early evacuation of clotted hemothorax. Am J Surg, 148(6), 786-790.
19. Eddy, A.C, Luna, G.K., Compass, M. (1989). Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J
Surg, 157(5), 494-497.
20. The Joint Commission. The Joint Commission’s Implementation Guide for NPSG.07.05.01 on Surgical Site Infections: The SSI Change Project.
Available at: https://www.jointcommission.org/assets/1/18/Implementation_Guide_for_NPSG_SSI.pdf
21. Mangram, A. J., Horan, T. C., Pearson, M. L., Silver, L. C., & Jarvis, W. R. (1999). Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease
Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control, 27(2), 97-132.
22 Bashir, M. H., Olson, L. K., & Walters, S. A. (2012). Suppression of regrowth of normal skin flora under chlorhexidine gluconate dressings applied
to chlorhexidine gluconate-prepped skin. Am J Infect Control, 40(4), 344-348. doi:10.1016/j.ajic.2011.03.030
23. National Collaborating Centre for Women’s and Children’s Health. (2008). Surgical Site Infection: Prevention and Treatment of Surgical Site Infection.
Available at: https://www.nice.org.uk/guidance/cg74
24. Abboud, E. C., Settle, J. C., Legare, T. B., Marcet, J. E., Barillo, D. J., & Sanchez, J. E. (2014). Silver-based dressings for the reduction of surgical site
infection: review of current experience and recommendation for future studies. Burns, 40 Suppl 1, S30-S39. doi:10.1016/j.burns.2014.09.011
25. Connery, S. A., Downes, K. L., & Young, C. (2012). A retrospective study evaluating silver-impregnated dressings on cesarean wound healing.
Adv Skin Wound Care, 25(9), 414-419. doi:10.1097/01.ASW.0000419407.37323.e8
26. Cavanagh, M. H., Burrell, R. E., & Nadworny, P. L. (2010). Evaluating antimicrobial efficacy of new commercially available silver dressings. Int
Wound J, 7(5), 394-405. doi:10.1111/j.1742-481X.2010.00705.x
27. Edmiston CE Jr, Bruden B, Rucinski MC, Henen C, Graham MB, Lewis BL. Reducing the risk of surgical site infections: does chlorhexidine gluconate
provide a risk reduction benefit? Am J Infect Control. 2013;41(5 Suppl):S49-55. doi: 10.1016/j.ajic.2012.10.030. Review. PubMed PMID: 23622749.
28. DeBaun, B. (2008). Evaluation of the antimicrobial properties of an alcohol-free 2% chlorhexidine gluconate solution. AORN J, 87(5), 925-933.
doi:10.1016/j.aorn.2008.02.001
29. Karki, S., & Cheng, A. C. (2012). Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated
infections and colonization with multi-resistant organisms: a systematic review. J Hosp Infect, 82(2), 71-84. doi:10.1016/j.jhin.2012.07.005
30. Hannan, M. M., O’Sullivan, K. E., Higgins, A. M., Murphy, A. M., McCarthy, J., Ryan, E., & Hurley, J. P. (2015). The combined impact of surgical team
education and chlorhexidine 2% alcohol on the reduction of surgical site Infection following cardiac surgery. Surg Infect (Larchmt), 16(6),
799-805. doi:10.1089/sur.2015.033
31. Schweizer, M. L., Chiang, H. Y., Septimus, E., et al. (2015). Association of a bundled intervention with surgical site infections among patients undergoing
cardiac, hip, or knee surgery. JAMA, 313(21), 2162-2171. doi:10.1001/jama.2015.5387
32. Dumville, J. C., Gray, T. A., Walter, C. J., et al. (2016). Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev, 12, CD003091.
doi: doi:10.1002/14651858.CD003091.pub4.
33. British Medical Association and Royal Pharmaceutical Society of Great Britain. (2011). British National Formulary (BNF): Appendix 8: wound
management products and elasticated garments. Available at: https://www.bnf.org/products/bnf-online/
34. Goldman, M.P., Fronek, A. (1992). Consensus Paper on Venous Leg Ulcer. The Journal of Dermatologic Surgery and Oncology, 18(7), 592-602.
doi:10.1111/j.1524-4725.1992.tb03513.x
35. Eloquest Healthcare. (2016). ReliaTect® Post-Op Dressing with CHG Instructions for Use. Data on file.
36. Anderson, D. J., Podgorny, K., Berrios-Torres, S. I., et al. (2014). Strategies to prevent surgical site infections in acute care hospitals: 2014 update.
Infect Control Hosp Epidemiol, 35(6), 605-627. doi: 10.1086/676022