Patient-specific risk factors can contribute to SSIs, and while some of these factors can be modified, others cannot.1
The following sections will provide more information about each of these risk factors and potential interventions to minimise these risks.
Diabetes Mellitus and Hyperglycaemia
Studies have shown that both insulin-dependent and non-insulin-dependent diabetic patients are at an increased risk for developing SSIs.5 This is due to poor immune function and delayed wound healing.
Diabetic patients need to have controlled blood glucose levels preoperatively, intraoperatively and postoperatively. Patients should receive insulin perioperatively to control hyperglycaemia and minimise the risk of adverse outcomes.6
Bacterial Colonisation and Coexisting Infections
Research shows that surgical sites containing more than 100,000 microorganisms per gram of tissue have a significantly greater risk of infection.
However, it is important to note that the number of microorganisms necessary to cause an infection is significantly lower when there is foreign material, such as surgical mesh, at the site.7
If a patient has an existing infection at the time of surgery, this also increases the likelihood of developing an SSI.1
1 Kirchhoff et al. Patient Safety in Surgery 2010, 4:5 http://www.pssjournal.com/content/4:5 JAMA Surg. 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904 Published online 3 May 2017. Corrected on 21 June 2017.
2 McGarry S, Engemann J, Schmader K, Sexton DJ, Kaye KS. Surgical Site Infection due to Staphylococcus Aureus in the Elderly: Mortality, Duration of Hospitalization and Cost. Infection Control & Hospital Epidemiology. 2004 Jun; 25(6): 461-467
3 Culebras JM. Malnutrition in the Twenty-First Century: An Epidemic Affecting Surgical Outcome. Surgical Infections. 2013 Jun; 14(3): 237-243
4 Huttunen R, Syrjänen J. Obesity and the Risk and Outcome of Infection. International Journal of Obesity. 2013 May; 37: 333-340
5 Ashar A, Valerian BT, Lee EC, Bestle SL, Elmendorf SL, Stain SC. The Effect of Diabetes Mellitus on Surgical Site Infections after Colorectal and Noncolorectal General Surgical Operations. The American Surgeon. 2010 Jul; 76(7): 697-702
6 Kwon S, Thompson R, Dellinger P, Yanez D, Farrohki E, Flum D. Importance of Perioperative Glycemic Control in General Surgery: A Report from the Surgical Care and Outcomes Assessment Program. Annals of Surgery. 2013 Jan; 257(1): 8-14
7 Monga. M., 2012. Ureteroscopy: Indications, Instrumentation & Technique. Springer Science & Business Media, p.211.
8 Belda FJ, Aguilera L, García de la Asunción J, Alberti J, Vicente R, Ferrándiz L, Rodríguez R, Company R, Sessler DI, Aguilar G, Botello SG, Ortí R; Spanish Reduccion de la Tasa de Infeccion Quirurgica Group. Supplemental Perioperative Oxygen and the Risk of Surgical Wound Infection: A Randomized Controlled Trial. JAMA. 2005 Oct 26;294(16):2035-42. Erratum in: JAMA. 2005 Dec; 294(23):2973.
9 Ismael H, Horst M, Farooq M, Jordon J, Patton JH, Rubinfeld IS. Adverse Effects of Preoperative Steroid Use on Surgical Outcomes. American Journal of Surgery. 2011 Mar; 201(3):305-8