The Journal of hospital infection
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Review
Antibiotic resistance in common pathogens reinforces the need to minimise surgical site infections.
Surgical site infections (SSIs) remain an important cause of postoperative morbidity and mortality and generate considerable additional healthcare and societal costs. Most SSIs are caused by skin-derived bacteria such as Staphylococcus aureus and coagulase-negative staphylococci. Antimicrobial resistance among these and other clinically important pathogens is an increasing problem. ⋯ Because the risk of developing SSI depends in part on the extent of wound contamination with virulent bacteria, efficient preoperative patient skin preparation is essential to decrease the number of potential wound contaminants. A recent development to reduce the risk of surgical site contamination by skin flora is a cyanoacrylate-based microbial sealant that is applied before surgery and dries to immobilise skin bacteria under a breathable film. This novel mechanism of action is not compromised by, and does not promote, bacterial resistance and, with minimal potential to cause skin reactions, the microbial sealant is an innovative addition to available options for SSI prophylaxis.
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Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. The incidence of SSIs may be as high as 20%, depending on the surgical procedure, the surveillance criteria used, and the quality of data collection. ⋯ Numerous patient-related and procedure-related factors influence the risk of SSI, and hence prevention requires a 'bundle' approach, with systematic attention to multiple risk factors, in order to reduce the risk of bacterial contamination and improve the patient's defences. The Centers for Disease Control and Prevention guidelines for the prevention of SSIs emphasise the importance of good patient preparation, aseptic practice, and attention to surgical technique; antimicrobial prophylaxis is also indicated in specific circumstances. Emerging technologies, such as microbial sealants, offer the ability to seal and immobilise skin flora for the duration of a surgical procedure; a strong case therefore exists for evaluating such technologies and implementing them into routine clinical practice as appropriate.