Surgical site infections – do we have a problem? Roland Andersson, Professor of Surgery, Vice Dean, Faculty of Medicine, Lund University, Sweden President Surgical Infection Society-Europe Surgical Infection Society – Turkey, March 6, 2015

Surgical site infections - clinical magnitude, and costs?

Health care-associated infections (HAIs) and SSIs Surgical site infections 2nd-3rd cause of HAIs in the US, contributing most to overall costs Zimlichman et al. JAMA Intern Med 2013;173:2039-46 Thompson et al. Ann Surg 2011; 254:430-37 SSI doubles hospital stay and costs. Bad business for hospital and the society! Broex et al. J Hosp Infect 2009; 72:193-201 Boltz et al. Surgery 2011; 150:934-42 Alexander et al. Ann Surg 2011; 253:1082-93

Surgical site infections US – health care associated infections (HAI) – 1.7 million infections, 99 000 deaths yearly, medical costs 45 billion USD. Patient with SSI – five times more likely to be readmitted within 30 days, twice as likely to die, prolonged hospital stay, costly! Thompson et al. Ann Surg 2011;254:430-37 Kirkland et al. Infect Contr Hosp Epidemiol 1999;20:725-30 Shepard et al. JAMA Surg 2013;148:907-14

Surgical site infections SSI – definition – clinical relevance? Discrepancy between what is reported in surgical databases and a microbiology – infection prevention database: sensitivity 57 vs 93 % for SSIs Donker et al. Surg Infect 2013; 14:397-400 SSIs – applicable for all specialities, worldwide and strains economy and overall care systems Preventing 30 day postoperative readmission (about 15 %) would save 620 million USD per year in the US Petroze et al. Surg Infect 2014; 15:386-86 Lawson et al. Ann Surg 2013; 258:10-18

Surgical site infections - what to do?

Surgical site infections - what to do? Success factors: Surgeon-specific feedback on the SSI rates considered most important factor for improvement (HPB) Ceppa et al. HPB 2013; 15:384-91 Surveillance and participation in a surveillance network, reduced the risk of SSI. Infection control teams. Geubbels et al. Int J Qual Health Care 2006; 18:127-33

Surgical site infections - what to do? Success factors: Surgical care improvement project (SCIP) including focus on perioperative infection prevention (prophylactic antibiotics within 1 hr before surgery, correct antibiotic selection, discontinuation of antibiotics within 24 hrs after surgery, well controlled blood glucose, discontinuation of urinary catheters, perioperative normothermia A trend towards decrease in developing SSI over time Munday et al. Am J Surg 2014; 208:835-40 Cataife et al. Med Care 2014; 52:s66-s73

Surgical site infections - what to do? Success factors: Introduction of SSI bundles reduce SSIs and postoperative sepsis, decrease length of stay and costs Keenan et al. JAMA Surg 2014; 49:1045-52 Thompson et al. Ann Surg 2011; 254:430-7 High volume centers is associated with a reduction in SSIs Vogel et al. Vasc Endovascular Surg 2011; 45:317-24 Boas et al. Am J Med Qual 2014; 12:1-6 Anderson et al. Ann Surg 2008; 247:343-49

Keenan et al. JAMA Surg 2014; 149:1045-52

Surgical site infections - what to do? Awareness of best practices in order to reduce SSIs: A multi-holder process, educational understanding of risk factors, epidemiology and novel strategies Leaper et al. Surg Infect 2010; 11:283-87 Skoufalos et al. Am J Med Qual 2012; 27:297-304 Further development of SCIP (surgical care improvement project). Improvement so far comparably limited. A case for more personalized medicine? Edmiston et al. Surg Infect 2011; 12:169-77

Surgical site infections - what to do? Awareness of best practices in order to reduce SSIs: Implementation of surgical site surveillance varying inbetween countries. A need for more accurate definitions and intensive recording. Effects from national data registries scarse Manniën et al. J Hosp Infect 2007; 66:224-31 Leaper et al. J Hosp Infect 2013; 83:83-86

Surgical site infections Time for a wake-up call as SSIs represent a substantial threath considering postoperative morbidity and mortality, and hospital and society costs Multi-facetted regime based on best possible evidence, has to be implemented Ignorance is not acceptable and there is no place for failure in improving outcome and preventing SSIs