PREVENTION of SSIs

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CHASING ZERO: THE DRIVE TO ELIMINATE SURGICAL SITE INFECTIONS

SSIs remain a substantial cause of morbidity, prolonged hospitalization, and death. SSI are the second most common hospital acquired infections in United States and the European Union and occur in approximately 2% to 5% of patients undergoing inpatient surgery worldwide 1. The incidence of SSI is doubled in high risk patients and in surgeries such as colorectal, SSIs can reach 30%. The outcome of Deep Sternal SSI can carry a mortality rate of up to 40%.

SSIs might result in 1,2

  • $10 billion of incremental hospital costs per year in US and ~7 billion per year in European union.
  • Increased length of post operative hospital stay by 7-10 days.
  • Directly attributable costs of SSIs range from $11,000 to $26,000 per infection.
    • In more complex infections involving a prosthetic joint or antimicrobial-resistant organism, the cost per case can exceed $90,000.
  • 2 - 11 times increased risk of death compared to infection free patients.

Systemic antibacterial solutions are not sufficiently effective due to low target penetration.

The insufficient penetration can be:

  •  Temporary due to surgery related trauma to the tissue.
  •  Constant due to the nature of the target area.
(1) Anderson, D.J. et al, Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update, Infect Control Hosp Epidemiol 2014;35(6):605-627
(2) Kirkland KB, et al. Clin Infect Dis. 2003

PERIOPERATIVE SYSTEMIC ANTIBIOTICS (IV, ORAL) PROPHYLAXIS IS NOT

ENOUGH…

  • Systemic antibiotics (IV or oral) used during the course of surgery, typically beginning an hour before surgery, are not effective to prevent all SSIs
  • The antibiotic penetration to the surgical wound during and post operation is significantly limited because of the surgical incision and the damage to blood vessels 1,2*
  • Systemic antibiotics may be limited in their ability to reach the target site due to surgical disruption of local blood supply.

*In CABG, left internal mammary artery (LIMA) harvesting further decrease antibiotic penetration ; Furthermore, Tissue perfusion is impaired in patients with diabetes or atherosclerosis, who are common in CABG / cardiac Surgery. 1 Cefazolin and linezolid penetration into sternal cancellous bone during coronary artery bypass grafting . Martin Andreas et al. European Journal of Cardio-Thoracic Surgery 48 (2015) 758–764 ; 2 Direct sternal administration of Vancomycin and Gentamicin during closure prevents wound infection. Andreas M. et al. Interactive CardioVascular and Thoracic Surgery (2017) 1–5