Overview
Surgical site infections (SSIs) occur after surgery in the part of the body where the surgery took place. These infections may involve only the skin, or may be more serious and involve tissue under the skin or organs. SSIs sometimes take days or months after surgery to develop so it is important to track patients after discharge for a period of time to assure that no infection has occurred.
Some patients may be at higher risk for developing a SSI due to age, underlying medical conditions, invasiveness of the surgery itself, duration of procedure, or other factors. It is important that both the patient and the healthcare providers take the appropriate steps to help prevent an infection.
Symptoms of a SSI may include:
- Fever
- Redness and/or pain around the surgical site
- Drainage of cloudy fluid from the surgical wound
Estimated burden of SSIs in acute care facilities in the United States:
- Morbidity
- 300,000 SSIs per year. (citation)
- 22% of all HAIs; only type of infection more common is UTI. (citation)
- 2%-5% of patients undergoing inpatient surgery develop a SSI. (citation)
- Each SSI is associated with approximately 7-10 additional postoperative hospital days. (citation)
- Mortality
- 3% mortality. (citation)
- 2-11 times higher risk of death compared with operative patients without a SSI. (citation)
- 77% of deaths among patients with SSI are directly attributable to SSI. (citation)
- Over 8% of the HAIs that were associated with deaths in the US were SSIs. (citation)
- Costs (citation)
- Estimated cost per infection ranges from $11,000 - $35,000
- Estimated total cost in the United States ranges from $3 billion - $10 billion annually
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Beginning in January 2012, the Centers for Medicare and Medicaid Services (CMS) will require acute care hospitals participating in their Inpatient Prospective Payment System (IPPS) to report SSIs following colon surgery and abdominal hysterectomy procedures. These data will be made publicly available on Hospital Compare.
VDH HAI Program activities to address this issue:
- SSI surveillance pilot (June 2010 - August 2011): Voluntary project in 18 hospitals to pilot test surveillance on coronary artery bypass graft (CABG), hip replacement, or knee replacement surgical procedures using NHSN definitions and software. Included training on definitions, conference calls with participants to discuss surveillance challenges, promotion of working with IT departments to automate data upload to NHSN, and measurement of time and effort for surveillance. Data on SCIP procedures related to antibiotic use (appropriate antibiotic, appropriate timing of antibiotic, and appropriate discontinuation of antibiotic) also collected. Most of the participating hospitals found it helpful in preparing for SSI reporting through NHSN required by CMS.
- Surgical site infection (SSI) surveillance pilot project, data presentation collaborative, and SSI mini-grant report
- SSI mini-grant program (June 2011 - November 2011): Disseminated funds to 22 hospitals to assist with implementation of the NHSN Procedure-Associated Module to help hospitals prepare for CMS reporting of colon surgeries and abdominal hysterectomies. Examples of grant recipient activities included programmer support to create electronic files to upload surgical procedure data, surveillance staff training, and modification of internal systems.
- Surgical site infection (SSI) surveillance pilot project, data presentation collaborative, and SSI mini-grant report
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Prevention Strategies for Healthcare Providers
To prevent SSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:
- Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery.
- Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient.
- If indicated, remove some of the patient’s hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur.
- Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.
- When indicated, give the patient antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery.
- Clean the skin at the site of the surgery with a special soap that kills germs.
SHEA/IDSA Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals - SSI
CDC SSI toolkit for hospitals – contains background on epidemiology of SSIs as well as core and supplemental prevention strategies
Surgical Care Improvement Project (SCIP) - a large national partnership dedicated to reducing the number of preventable surgical complications, including SSIs. SCIP includes a number of steps that surgeons, anesthesiologists, nurses, and patients can take to lower the risk of surgical complications. Examples: appropriate antibiotic, appropriate discontinuation of antibiotics, and appropriate hair removal.
WHO Surgical Safety Checklist – tool for use by clinicians to improve the safety of their operations and reduce surgical deaths and complications. Applicable for national and international settings.
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Tools and Resources
APIC Guide to the Elimination of Orthopedic Surgical Site Infections, 2010
Guideline for Prevention of Surgical Site Infection, 1999
NHSN Procedure-Associated Module – protocol and instructions, training, and forms
- NHSN defines three types of SSIs:
- Superficial incisional SSI –involves only skin and subcutaneous tissue or the incision and occurs within 30 days after the operative procedure.
- Deep incisional SSI – involves deep soft tissues (fascia and/or muscle layers) of the incision and occurs within 30 days after the operative procedure if no implant is left in place or within one year if an implant is in place.
- Organ space SSI – involves any part of the body (excluding the skin incision, fascia, or muscle layers) that is opened or manipulated during the operative procedure and occurs within 30 days after the operative procedure if no implant is left in place or within one year if an implant is in place.
SHEA Patient Education Guide (SSI)– fact sheet that educates patients and their families about 7 types of HAIs (including SSIs) and how to work with healthcare professionals to prevent them.
Consumer tips for safe surgery
For more patient resources, please see the Consumer and Public Information page or go to the CDC SSI website.
