According to the CDC, surgical site infections (SSIs) 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. The CDC believes the human and financial costs of treating surgical site infections (SSIs) are on the rise. As the population ages, more surgeries are being performed—and more patients have one or more chronic conditions that could put them at risk for adverse events, including an SSI.
SSIs are usually defined as infections that manifest at the incision site within 30 days of surgery. Some of these infections are superficial, involving only the skin around the surgical incision. Others are more serious and involve vital organs or tissues under the skin. 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. Any type of SSI can turn into sepsis, so hospitals take them very seriously. The CDC estimates that roughly half of SSIs are preventable, by using evidence-based strategies.
Earlier this year, the CDC released an update to its guidelines for preventing SSIs. This is the first update since the 1999 guidelines, which were published before it was commonplace to base clinical guidelines on evidence-based evaluations. The old guidelines were based on expert opinions. The new guidelines are based on a review and analysis of 170 relevant studies. A panel evaluated the quality of the evidence in each study to give each recommendation a strength level that ranges from “strong recommendation with evidence of high to moderate quality” to “no recommendation/unresolved issue.”
The review process and subsequent updates to the old guidelines came with a surprise: Of 42 recommendations, 25 of them were found not to be evidence-based and were downgraded to “unresolved issue.” The recommendations cover 14 core areas that hospitals can incorporate into their existing quality improvement programs for great patient safety after surgery. But clearly there are now huge knowledge gaps regarding what does and doesn’t work to prevent SSIs and which practices may cause more harm than good. The authors of the new guidelines noted that the many unresolved issues indicate a need for more research studies that assess the effectiveness of specific interventions.
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.
The current, industry-wide focus on reducing HAIs is expanding career opportunities for nurses who want to specialize in infection prevention. Are you interested in keeping patients safe from pathogens in a hospital environment? If planning, implementing, and evaluating infection prevention and control measures appeals to you, consider making this in-demand 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.