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Infection Prevention CSSD

The global problem of post-operative infections

Surgical site infection (SSI) is the most frequent type of health care-associated infection (HAI) in low- and middle-income countries, LMICs, [1] (68% of the world‘s countries [2]). According to WHO reports, approximately 1 in 10 people who have surgery in LMICs acquire SSIs. In addition to the risk and discomfort for the patient, SSIs dramatically increase the direct and indirect cost of treatment and reduce health-related quality of life. [3]

Chart for the global problem of post-operative infections

SSI incidence in Latin America – Example Mexico

When compared to the International Nosocomial Infection Control Consortium data, SSI rates in Mexico were significantly higher in 73% of the analyzed surgical procedures. [8] This may result from the typical hospital situation in limited-resource countries where there is often a lack of standard procedures, local differences in guidelines and poor infrastructure. [9], [10]

  • SSI rates

    0%

    higher!

Surgical instruments pose risk of contamination

Surgical instruments could act as fomites for the pathogens of surgical site infection even if the surgical field is not evidently contaminated. [11]

Low- and middle-income countries

Chart for low- and middle-income countries

Prevention of surgical site infections starts with instrument reprocessing

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The avoidance of SSIs protects patients from serious complications

Chart for the avoidance of SSIs protects patients from serious complications

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  • The global problem of post-operative infections

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[1] WHO Protocol for surgical site infection surveillance with a focus on settings with limited resources, 2018.

[2] Rosenthal VD, Richtmann R, Singh S, Apisarnthanarak A, Kübler A, Viet-Hung N et al. Surgical Site Infections, International Nosocomial Infection Control Consortium Report, Data Summary of 30 Countries, 2005–2010. Infect Control Hosp Epidemiol. 2013 Jun;34(6):597-604.

[3] Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Infect Control Hosp Epidemiol. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. 2011 Feb;32(2):101-14. doi:10.1086/657912.

[4] World Health Organization, 2016. Hand hygiene and the surgical patient journey. [Online] Available at: 1 [Accessed 23 January 2024].

[5]  Wiseman JT, Fernandez-Taylor S, Barnes M, et al. Predictors of surgical site infection after hospital discharge in patients undergoing major vascular surgery. J Vasc Surg. 2015;62(4):1023-31.

[6] Title : Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017, Published Date : August 1, 2017 Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017 (cdc.gov)  accessed 23.01.2024.

[7] Centers for Disease Control and Prevention. (CDC). 9 Surgical Site Infection (SSI) Event (apic.org) (accessed 23.01.2024).

[8] Portillo-Gallo JH, Miranda-Novales MG, Rosenthal VD, Sánchez M, Ayala-Gaytan JJ, Ortiz-Juárez VR et al. Surgical site infection rates in four Mexican cities: Findings of the International Nosocomial Infection Control Consortium (INICC). J Infect Public Health. 2014 Nov-Dec;7(6):465-71.

[9] Charry L, Andrade PC, Cabra H. Systematic Review of Clinical and Economic Outcomes Related to Surgical Site Infections in Latin America. Value in Health 2016 Nov;19(3), A223.

[10] WHO Health care-associated infections FACT SHEET 9789241501507_eng.pdf (who.int) accessed 23.01.2024.

[11] Saito Y, Kobayashi H, Uetera Y, Yasuhara H, Kajiura T, Okubo T. Microbial contamination of surgical instruments used for laparotomy. American Journal of Infection Control, Volume 42, Issue 1, 43-47.

[12] Allegranzi B Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta analysis. Lancet. 2011 Jan 15;377(9761):228-41.

[13] Gaynes RP, Culver DH, Horan TC, Edwards JR, Richards C, et al. (2001) Surgical site infection (SSI) rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 33: 69-77.

[14] Gastmeier P, Geffers C, Brandt C, Zuschneid I, Sohr D, et al. (2006) Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect 64: 16-22.

[15] Conway LJ1, Pogorzelska M, Larson EL, Stone PW. Surgical Site Infection Prevention Policies and Adherence in California Hospitals, 2010. Infect Control Hosp Epidemiol. 2012 Jun; 33(6): 640-1.

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