Top

Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

01-02-2013 | Review Article/Brief Review

Review article: The anesthesiologist’s role in the prevention of surgical site infections

Authors: Shawn S. Forbes, MD, Richard F. McLean, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 2/2013

Abstract

Purpose

To highlight the role of anesthesiologists in the prophylaxis of surgical site infections (SSIs) and to recognize the central role they play in quality improvement initiatives for the prevention of SSIs.

Source

The medical literature was searched with a focus on three interventions affecting the risk of SSIs: preoperative antibiotic administration, perioperative normothermia, and perioperative hyperoxia. The literature was also searched for examples of initiatives in patient safety and quality improvement that highlight the role of anesthesiologists in preventing SSIs.

Principal findings

The timely administration of preoperative antibiotics and the maintenance of perioperative normothermia have been shown to reduce the risk of SSI significantly. Perioperative hyperoxia in the prevention of SSIs remains controversial but may improve outcomes in specific subsets of the surgical population. Initiatives in quality improvement show the challenges faced by many centres to improve upon these processes of care, but they also highlight the role of anesthesiologists as champions in the multidisciplinary efforts for the prevention of SSIs.

Conclusions

Anesthesiologists are responsible for many of the processes of care shown to impact the risk for SSIs, and they play an important role in the prevention of SSIs. Their leadership in the multidisciplinary efforts to improve the quality of the surgical patient is of critical importance.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Guideline for Prevention of Surgical Site Infection. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999; 27: 97-132. quiz 133-4; discussion 96.PubMedCrossRef

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992; 20: 271-4.PubMedCrossRef

Daneman N, Lu H, Redelmeier DA. Discharge after discharge: predicting surgical site infections after patients leave hospital. J Hosp Infect 2010; 75: 188-94.PubMedCrossRef

Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990 s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20: 725-30.PubMedCrossRef

Ministry of Health and Long-Term Care. Patient Safety. 2011; Available from URL: http://www.health.gov.on.ca/en/public/programs/patient_safety/ (accessed August 2012).

Darouiche RO, Wall MJ Jr, Itani KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010; 362: 18-26.PubMedCrossRef

Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surgery 1961; 50: 161-8.PubMed

Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38: 1706-15.PubMedCrossRef

Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992; 326: 281-6.PubMedCrossRef

10.

Bratzler DW, Houck PM, Richards C, et al. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg 2005; 140: 174-82.PubMedCrossRef

11.

Forbes SS, Stephen WJ, Harper WL, et al. Implementation of evidence-based practices for surgical site infection prophylaxis: results of a pre- and postintervention study. J Am Coll Surg 2008; 207: 336-41.PubMedCrossRef

12.

Kanter G, Connelly NR, Fitzgerald J. A system and process redesign to improve perioperative antibiotic administration. Anesth Analg 2006; 103: 1517-21.PubMedCrossRef

13.

Jernigan JA, Pullen AL, Flowers L, Bell M, Jarvis WR. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003; 24: 409-14.PubMedCrossRef

14.

Matsukawa T, Sessler DI, Sessler AM, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology 1995; 82: 662-73.PubMedCrossRef

15.

Kumar S, Wong PF, Melling AC, Leaper DJ. Effects of perioperative hypothermia and warming in surgical practice. Int Wound J 2005; 2: 193-204.PubMedCrossRef

16.

Polderman KH. Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 2009; 37(7 Suppl): S186-202.PubMedCrossRef

17.

Arrich J, Holzer M, Herkner H, Mullner M. Cochrane corner: hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Anesth Analg 2010; 110: 1239.PubMed

18.

Schwartz BG, Kloner RA, Thomas JL, et al. Therapeutic hypothermia for acute myocardial infarction and cardiac arrest. Am J Cardiol 2012; 110: 461-6.PubMedCrossRef

19.

Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduced the incidence of morbid cardiac events. A randomized clinical trial. JAMA 1997; 277: 1127-34.

20.

Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996; 334: 1209-15.PubMedCrossRef

21.

Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. 2001; 358: 876-80.

22.

23.

Camus Y, Delva E, Cohen S, Lienhart A. The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery. Acta Anaesthesiol Scand 1996; 40: 779-82.PubMedCrossRef

24.

Smith CE, Gerdes E, Sweda S, et al. Warming intravenous fluids reduces perioperative hypothermia in women undergoing ambulatory gynecological surgery. Anesth Analg 1998; 87: 37-41.PubMed

25.

Camus Y, Delva E, Sessler DI, Lienhart A. Pre-induction skin-surface warming minimizes intraoperative core hypothermia. J Clin Anesth 1995; 7: 384-8.PubMedCrossRef

26.

Lindwall R, Svensson H, Soderstrom S, Blomqvist H. Forced air warming and intraoperative hypothermia. Eur J Surg 1998; 164: 13-6.PubMedCrossRef

27.

Leung KK, Lai A, Wu A. A randomised controlled trial of the electric heating pad vs forced-air warming for preventing hypothermia during laparotomy. Anaesthesia 2007; 62: 605-8.PubMedCrossRef

28.

Farnell S, Maxwell L, Tan S, Rhodes A, Philips B. Temperature measurement: comparison of non-invasive methods used in adult critical care. J Clin Nurs 2005; 14: 632-9.PubMedCrossRef

29.

Lawson L, Bridges EJ, Ballou I, et al. Accuracy and precision of noninvasive temperature measurement in adult intensive care patients. Am J Crit Care 2007; 16: 485-96.PubMed

30.

Babior BM. Oxygen-dependent microbial killing by phagocytes (first of two parts). N Engl J Med 1978; 298: 659-68.PubMedCrossRef

31.

Hopf HW, Hunt TK, West JM, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 1997; 132: 997-1004.PubMedCrossRef

32.

Govinda R, Kasuya Y, Bala E, et al. Early postoperative subcutaneous tissue oxygen predicts surgical site infection. Anesth Analg 2010; 111: 946-52.PubMed

33.

Greif R, Akca O, Horn EP, Kurz A, Outcomes Research Group. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 2000; 342: 161-7.PubMedCrossRef

34.

Myles PS, Leslie K, Chan MT, ENIGMA Trial Group, et al. Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial. Anesthesiology 2007; 107: 221-31.PubMedCrossRef

35.

Pryor KO, Fahey TJ III, Lien CA, Goldstein PA. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA 2004; 291: 79-87.PubMedCrossRef

36.

Belda FJ, Aguilera L, Garcia de la Asuncion J, Spanish Reduccion de la Tasa de Infeccion Quirurgica Group, et al. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA 2005; 294: 2035-42.PubMedCrossRef

37.

Bickel A, Gurevits M, Vamos R, Ivry S, Eitan A. Perioperative hyperoxygenation and wound site infection following surgery for acute appendicitis: a randomized, prospective, controlled trial. Arch Surg 2011; 146: 464-70.PubMedCrossRef

38.

Gardella C, Goltra LB, Laschansky E, et al. High-concentration supplemental perioperative oxygen to reduce the incidence of postcesarean surgical site infection: a randomized controlled trial. Obstet Gynecol 2008; 112: 545-52.PubMedCrossRef

39.

Mayzler O, Weksler N, Domchik S, Klein M, Mizrahi S, Gurman GM. Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery? Minerva Anestesiol 2005; 71: 21-5.PubMed

40.

Meyhoff CS, Wetterslev J, Jorgensen LN, PROXI Trial Group, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA 2009; 302: 1543-50.PubMedCrossRef

41.

Qadan M, Akca O, Mahid SS, Hornung CA, Polk HC Jr. Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials. Arch Surg 2009; 44: 359-66.CrossRef

42.

Zingg W, Cartier-Fassler V, Walder B. Central venous catheter-associated infections. Best Pract Res Clin Anaesthesiol 2008; 22: 407-21.PubMedCrossRef

43.

Zingg W, Sax H, Inan C, et al. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. Journal of Hospital Infection 2009; 73: 41-6.PubMedCrossRef

44.

Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355: 2725-32.PubMedCrossRef

45.

Loftus RW, Muffly MK, Brown JR, et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg 2011; 112: 98-105.PubMedCrossRef

46.

Loftus RW, Brown JR, Koff MD, et al. Multiple reservoirs contribute to intraoperative bacterial transmission. Anesth Analg 2012; 114: 1236-48.PubMedCrossRef

47.

Haynes AB, Weiser TG, Berry WR, Safe Surgery Saves Lives Study Group, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360: 491-9.PubMedCrossRef

48.

Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010; 304: 1693-700.PubMedCrossRef

49.

de Vries EN, Prins HA, Crolla RM, SURPASS Collaborative Group, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010; 363: 1928-37.PubMedCrossRef

50.

Dellinger EP, Hausmann SM, Bratzler DW, et al. Hospitals collaborate to decrease surgical site infections. Am J Surg 2005; 190: 9-15.PubMedCrossRef

51.

Merchant R, Bosenberg C, Brown K, et al. Guidelines to the Practice of Anesthesia: Revised edition 2011. Can J Anesth 2011; 58: 74-107.PubMedCrossRef

Title: Review article: The anesthesiologist’s role in the prevention of surgical site infections
Authors: Shawn S. Forbes, MD
Richard F. McLean, MD
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 2/2013
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-012-9858-6

At a glance: The STEP trials

Springer Medicine

Review article: The anesthesiologist’s role in the prevention of surgical site infections

Abstract

Purpose

Source

Principal findings

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Source

Principal findings

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2013

The next step: optimizing preoperative functional fitness and nutritional intervention

Opportunities to enhance perioperative patient safety: 2013 and beyond

Inhaled nitric oxide in patients with the acute respiratory distress syndrome secondary to the 2009 influenza A (H1N1) infection in Canada

Review article: Risks of anemia and related management strategies: can perioperative blood management improve patient safety?

Epidural analgesia in parturients with ankylosing spondylitis: A role for ultrasound surveillance and ultrasound-guided placement

Erratum to: Real-time ultrasound-guided spinal anesthesia using the SonixGPS® needle tracking system: a case report