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Strategies to Prevent Surgical Site Infections in Acute Care Hospitals

Published online by Cambridge University Press:  02 January 2015

Deverick J. Anderson
Duke University Medical Center, Durham, North Carolina
Keith S. Kaye
Duke University Medical Center, Durham, North Carolina
David Classen
University of Utah, Salt Lake City
Kathleen M. Arias
Association for Professionals in Infection Control and Epidemiology, Washington, D.C.
Kelly Podgorny
Joint Commission, Oakbrook Terrace, Chicago
Helen Burstin
National Quality Forum, Washington, D.C.
David P. Calfee
Mount Sinai School of Medicine, New York, New York
Susan E. Coffin
Children's Hospital of Philadelphiaand University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Erik R. Dubberke
Washington University School of Medicine, St. Louis, Missouri
Victoria Fraser
Washington University School of Medicine, St. Louis, Missouri
Dale N. Gerding
Loyola University Chicago Stritch School of Medicine, Chicago Hines Veterans Affairs Medical Center, Hines, Illinois
Frances A. Griffin
Institute for Healthcare Improvement, Cambridge
Peter Gross
Hackensack University Medical Center, Hackensack, New Jersey University of Medicine and Dentistry–New Jersey Medical School, Newark, New Jersey
Michael Klompas
Brigham and Women's Hospitaland Harvard Medical School, Boston, Massachusetts
Evelyn Lo
University of Manitoba, Winnipeg, Canada
Jonas Marschall
Washington University School of Medicine, St. Louis, Missouri
Leonard A. Mermel
Warren Alpert Medical School of Brown Universityand Rhode Island Hospital, Providence, Rhode Island
Lindsay Nicolle
University of Manitoba, Winnipeg, Canada
David A. Pegues
David Geffen School of Medicine at the University of California, Los Angeles
Trish M. Perl
Johns Hopkins Medical Institutions and University, Baltimore, Maryland
Sanjay Saint
Ann Arbor Veterans Affairs Medical Center and theUniversity of Michigan Medical School, Ann Arbor, Michigan
Cassandra D. Salgado
Medical University of South Carolina, Charleston
Robert A. Weinstein
Stroger (Cook County) Hospital andRush University Medical Center, Chicago
Robert Wise
Joint Commission, Oakbrook Terrace, Chicago
Deborah S. Yokoe
Brigham and Women's Hospitaland Harvard Medical School, Boston, Massachusetts


Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals to implement and prioritize their surgical site infection (SSI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.

1. Burden of SSIs as complications in acute care facilities.

a. SSIs occur in 2%-5% of patients undergoing inpatient surgery in the United States.

b. Approximately 500,000 SSIs occur each year.

2. Outcomes associated with SSI

a. Each SSI is associated with approximately 7-10 additional postoperative hospital days.

b. Patients with an SSI have a 2-11 times higher risk of death, compared with operative patients without an SSI.

i. Seventy-seven percent of deaths among patients with SSI are direcdy attributable to SSI.

c. Attributable costs of SSI vary, depending on the type of operative procedure and the type of infecting pathogen; published estimates range from $3,000 to $29,000.

i. SSIs are believed to account for up to $10 billion annually in healthcare expenditures.

1. Definitions

a. The Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System and the National Healthcare Safety Network definitions for SSI are widely used.

b. SSIs are classified as follows (Figure):

i. Superficial incisional (involving only skin or subcutaneous tissue of the incision)

ii. Deep incisional (involving fascia and/or muscular layers)

iii. Organ/space

SHEA/IDSA Practice Recommendations
Copyright © The Society for Healthcare Epidemiology of America 2008

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