Prevention of surgical site infections

Surgical site infection (SSI) is a common and potentially preventable post-operative complication. It has significant implications in terms of morbidity, mortality, length of hospital stay, readmission rate, post-hospital care and cost. Awareness and modification of pertinent risk factors is an important part of decreasing the rate of SSI. Risk factors may be related to either the patient or the operation itself. Pre-operative patient preparation includes bathing, appropriate hair removal and screening and eradication of potential pathogens. Use of antibiotic prophylaxis is only indicated for clean surgery when a foreign body is introduced, but is standard for clean-contaminated and contaminated procedures, albeit with several important caveats. Many fundamental day-to-day theatre practices are chiefly aimed at reduction of surgical site infection including standardized attire, hygiene protocols, hand scrubbing, skin preparation and draping. Environmental factors such as positive pressure ventilation are also aimed at producing a sterile environment. Special mechanisms such as laminar flow are used in high-risk surgery such as major joint replacement. Large quantities of devitalized tissue or wound haematoma should be prevented and therefore good surgical technique is also essential. Finally appropriate post-operative wound care and patient education are also vital components in preventing potentially hazardous wound infections.