Analyzing the risk factors influencing surgical site infections: the site of environmental factors

Abstract

Background: Addressing surgical site infection (SSI) is accomplished, in part, through studies that attempt to clarify the nature of many essential factors in the control of SSI. We sought to examine the link between multiple risk factors, including environmental factors, and SSI for prevention management. Methods:We conducted a longitudinal prospective study to identify SSIs in all patients who underwent interventions in 2014 in 8 selected hospitals on the Mediterranean coast of Spain. Risk factors related to the operating theatre included level of fungi and bacterial contamination, temperature and humidity, air renewal and differential air pressure. Patient-related variables included age, sex, comorbidity, nutrition level and transfusion. Other factors were antibiotic prophylaxis, electric versus manual shaving, American Society of Anaesthesiologists physical status classification, type of intervention, duration of the intervention and preoperative stay.Results: Superficial SSI was most often associated with environmental factors, such as environmental contamination by fungi (from 2 colony-forming units) and bacteria as well as surface contamination. When there was no contamination in the operating room, no SSI was detected. Factors that determined deep and organ/space SSI were more often associated with patient characteristics (age, sex, transfusion, nasogastric feeding and nutrition, as measured by the level of albumin in the blood), type of intervention and preoperative stay. Antibiotic prophylaxis and shaving with electric razor were protective factors for both types of infection, whereas the duration of the intervention and the classification of the intervention as "dirty" were shared risk factors. Conclusion:Our results suggest the importance of environmental and surface contamination control to prevent SSI.Contexte : La lutte contre les infections du site opératoire (ISO) passe entre autres par des études visant à clarifier la nature de nombreux facteurs essentiels de contrôle. Nous avons donc cherché à examiner le lien entre divers facteurs de risque, notamment de nature environnementale, et les ISO, dans une optique de prévention.

An Incision Closure Bundle for Colorectal Surgery

“…Surgeons often irrigate the surgical site throughout a procedure with sterile saline to improve visibility, keep tissues moist, and remove contaminants, although this is not universally practiced. Despite the potential benefit of surgical irrigation, there is virtually no standardization of the practice across all surgical specialties, and no official guideline from any major professional or accrediting organization . The type of irrigation fluid, additives (eg, antiseptics, antibiotics), volume, and delivery method vary widely and are rarely reflected in departmental protocols or SSI prevention bundles …”

Minimizing Sources of Airborne, Aerosolized, and Contact Contaminants in the OR Environment

“…The likelihood, severity, and type of an SSI can be dependent on intrinsic factors, such as the patient's age and underlying comorbidities and the type and length of the surgical procedure 4 . Extrinsic factors in the OR, such as health care provider (HCP) behavior and practices that modify air movement, the physical environment, equipment, or surgical instruments, also can increase microbial contamination and the risk of SSI development 5‐13 . Patients and HCPs can help control the effects of these intrinsic and extrinsic factors with practices such as cessation of smoking, preoperative bathing, preoperative prophylactic antibiotics, alcohol‐based patient skin antisepsis, and maintenance of body temperature 2,4 …”

“…In the OR environment, microbial contamination can occur through an airborne or contact route. The potential exists for microbes to infect the surgical incision through one of these routes, resulting in a reported association between OR contaminants and SSIs 5,6,8,11 . However, not every study has found a strong link between air or surface contamination and infection 7 .…”

“…Body secretions; frequent inadvertent touching of items and surfaces with contaminated hands or gloves; and the use of sophisticated, difficult‐to‐clean instruments and equipment all can contribute to contamination. Researchers can measure surface contamination by culturing specific microorganisms; assessing CFUs, adenosine triphosphate (ATP), and relative light units (RLUs); visually inspecting surfaces; and using fluorescent marking gel with allocation‐of‐contamination ratings 5,7,9,13,15,40,46‐50 . Microorganisms identified in a few of the studies that examined surface contamination included S aureus , methicillin‐resistant S aureus , S epidermidis , Enterobacter , Acinetobacter species, and Pseudomonas species 19,47‐49,51,52 …”

“…Alfonso‐Sanchez et al 5 examined contamination of OR surfaces and its association with SSIs in a longitudinal multifacility prospective study with a sample size of 18,910 patients. The researchers reported an overall 6.7% rate of SSI, but the rate of SSI was minimal in the absence of CFUs and environmental or surface contamination (0.34%).…”