1. 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

2. Surgical site infections - clinical magnitude, and costs?

3. 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:
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:
Boltz et al. Surgery 2011; 150:934-42
Alexander et al. Ann Surg 2011; 253:

4. Surgical site infections
US – health care associated infections (HAI) – 1.7 million infections, 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

5. 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:
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

6. Surgical site infections - what to do?

7. 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

8. 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

9. 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:
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

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

12. 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:
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

13. 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

14. 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