Reducing Surgical Site Infections

Reducing Surgical Site InfectionsIt takes a multi-modal approach to reduce surgical site infections. As frontline caregivers, nurses can help surgical patients avoid an SSI through adequate post-operative wound care and thorough discharge planning. Additionally, the infection control department can work with surgical staff and the sterile processing department to ensure compliance with core prevention strategies.

According to the CDC, surgical site infections (SSI) make up 17 percent of all hospital-acquired infections, making them the second most common type of HAI, right after catheter-associated UTIs. Each SSI is associated with additional postoperative hospital days and costs ranging from $3,000 to $29,000. From the patient’s perspective, an SSI delays healing, increases recovery time and time away from work, and brings additional pain and risk of complications (including the risk of sepsis, long-term disabilities, or even death).

SSIs are usually defined as infections that manifest within 30 days of a surgical procedure, and affect either the incision itself or deep tissue at the operation site. They occur when pathogens are able to gain access to areas of the body that were exposed during surgery and to multiply within the body. As the patient’s immune system reacts to the microbial invaders, the patient may develop pus, inflammation, swelling, pain or tenderness, and fever.

The risk of SSI (and strategies related to prevention) is related to the type of surgery being performed, as well as to the patient’s individual risk factors. These include age, immunological status, weight, nutritional status, glycemic control, and whether or not the patient is a smoker. The patient’s natural flora also comes into play. Some hospital infection control departments have implemented pre-operative screening for MRSA, with decolonization procedures undertaken upon a positive test.

Today, post-op hospital stays can be quite short and many surgeries now take place in ambulatory surgical centers – meaning an SSI may not manifest until after discharge, when the patient is at home. Some of these patients will require readmission for IV antibiotics or surgical intervention (if the infection is in deep tissue) while others may receive oral antibiotics on an outpatient basis (if the infection is superficial to the incision).

Clearly, nurses must advocate for surgical patients not only by giving them explicit wound care instructions, but by ensuring that the patient understands them. This means delivering the information in a manner that is culturally appropriate and targeted to the patient’s level of health literacy, perhaps using a patient education method like teach-back. Case managers might also target certain surgical patients for post-discharge surveillance, in order to prevent an SSI and/or identify it quickly for early intervention. For example, an elderly patient might need extra help with wound care or getting to a post-op follow-up appointment.

The CDC’s latest recommendations are compiled in the Guideline for Prevention of Surgical Site Infection (PDF). And if you’re interested in planning, implementing, and evaluating infection prevention and control measures, consider making this field your career specialty. As a first step, you can develop new skills and empower yourself with knowledge through an online RN to MSN degree with a specialization in infection control from American Sentinel University, an innovative, accredited provider of online nursing degrees.