Prevention of surgical site infection (SSI)

Surgical site infections (SSI) in cardiac and vascular surgery

With more than 410,000 surgical interventions on the heart and almost 770,000 on blood vessels, the specialist areas of cardiac and vascular surgery accounted for almost 7% of the nearly 17 million operations documented in German hospitals in 2018. The most common procedures included the implantation of pacemakers and defibrillators, cor- onary artery bypass grafting, the ligation, excision and stripping of varicose veins, as well as endarterectomy. ¹

Postoperative wound infections (SSI) are the most common nosocomial infections in German acute-care hospitals, accounting for approximately 24% of all infections.²  The SSI rates vary depending on the type of operation. This also applies to wound infection rates in cardiac and vascular surgery.

• At an average infection rate of 2.5, coronary artery bypass grafting that involves harvesting of autologous vessels from the extremities (thoracic wound) has the highest SSI rate in cardiac surgery. ³
• In vascular surgery, reconstructions of arteries in the lower extremities are particularly frequently associated with postoperative wound infections, the average rate being 4.71. ³

The economic aspects of SSI

Apart from the serious health consequences that SSI can have for the affected patients, they also take a heavy economic toll on hospitals and healthcare systems, including due to prolonged hospital stays. This was established, for instance, by a study from England. ⁴

Longer hospital stays with additional costs due to SSI ⁴

Postoperative inpatient stay in days.

According to the European Centre for Disease Prevention and Control (ECDC), 20%–30% of all nosocomial infections can be avoided by implementing targeted hygiene and control programmes.⁵

References:

1) German Federal Health Monitoring Information System – jointly organised by RKI and DESTATIS. Operations and procedures in hospital inpatients. http://www.gbe-bund.de/oowa921-install/servlet/ oowa/aw92/WS0100/_XWD_PROC?_XWD_2/1/XWD_CUBE.DRILL/_XWD_30/D.390/43135

(Last accessed: September 2020).

2) Prevention of postoperative wound infections, KRINKO recommendation – April 2018. A presentation to support the implementation of the recommendation M. Thanheiser (FG 14 RKI) https://www.rki.de/DE/Content/Infekt/ Krankenhaushygiene/Kommission/Ergaenzende Informationen/Muster-KRINKOSSI-

Rili_2018.pdf?__blob=publicationFile (Last accessed: October 2023).

3) HISS Hospital Infection Standardised Surveillance programme Module OR HISS Calculation period: January 2017 to December 2019. Date created: 6 March 2020. https://www.nrz-hygiene.de/files/ Referenzdaten/OP/201701_201912_OPRef.pdf (Last accessed: October 2023).

4) Jenks PJ et al. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from

an English hospital. J Hosp Infect. 2014;86(1):24–33.

5) Assadian O., Burgmann H., Ernst I. et al. Hüft- und Knie-Endoprothetik – Empfehlungen zur Infektions-Prophylaxe. AN 2019;4a.