Surgical site infections: prevention and treatment

Context

Surgical site infection is a type of healthcare-associated infection in which a wound infection occurs after an invasive (surgical) procedure. Other types of healthcare-associated infections that mainly affect surgical patients are postoperative respiratory and urinary tract infections, bacteraemias (including methicillin-resistant Staphylococcus aureus infections and intravascular cannula infections) and antibiotic-related diarrhoeas (particularly Clostridium difficile enteritis). Surgical site infections have been shown to compose up to 20% of all healthcare-associated infections. At least 5% of patients undergoing a surgical procedure develop a surgical site infection.

A surgical site infection may range from a spontaneously limited wound discharge within 7 to 10 days of an operation to a life-threatening postoperative complication, such as a sternal infection after open heart surgery. Most surgical site infections are caused by contamination of an incision with microorganisms from the patient's own body during surgery. Infection caused by microorganisms from an outside source following surgery is less common. Most surgical site infections are preventable. Measures can be taken in the pre-, intra- and postoperative phases of care to reduce the risk of infection.

Surgical site infections can have a significant effect on quality of life for the patient. They are associated with considerable morbidity and extended hospital stay. In addition, surgical site infections result in a considerable financial burden to healthcare providers. Advances in surgery and anaesthesia have resulted in patients who are at greater risk of surgical site infections being considered for surgery. In addition, increased numbers of infections are now being seen in primary care because patients are allowed home earlier following day case and fast-track surgery.

The guideline makes recommendations for prevention and management of surgical site infections based on rigorous evaluation of the best available published evidence.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform their decisions for individual patients. In addition, published identified characteristics of appropriate interactive dressings and antimicrobial products should be considered before use, and local formularies and guidelines based on local microbial resistance patterns should be used to inform choice of antibiotics.

In 2017, the NICE surveillance team reviewed the guideline and identified new evidence on nasal decolonisation, skin antiseptics, the use of antiseptics and antibiotics before wound closure, and closure methods. This evidence has been reviewed and the recommendations in these areas updated.