Francesco M. Labricciosa, MD, Public Health Specialist
Safe surgical care is an important component of health systems worldwide. However, surgical site infections (SSIs) remain common, costly, and disproportionately prevalent despite significant improvements in perioperative care.
SSIs increase morbidity, lengthen hospital stay, healthcare costs for patients and healthcare systems, and contribute to mortality and disparities, particularly in low- and middle-income countries (LMICs). Many SSIs are preventable, and represent an important indicator of the quality of care and a major patient safety concern in healthcare.
In a paper recently published in Surgical Infections, Massimo Sartelli, together with an international and multidisciplinary group of physicians and experts, provides a comprehensive perspective on the global burden of SSIs and the challenges and opportunities for their prevention.
Infection prevention and control (IPC) is a cornerstone of global surgery, but its implementation is limited by several factors, such as inadequate infrastructure and supplies, insufficient sterile processing capacity, shortages of trained personnel, weak quality assurance, and inadequate water supply. Sterile processing facilities lack quality assurance systems, trained staff, and resources.
Environmental factors, including airborne particulate matter, surface bioburden, and ventilation, also remain insufficiently characterized. However, persistent gaps reflect not only resource constraints but also human factors, including outdated guidelines, inadequate adaptation to local contexts, and weak safety cultures.
SSI prevention and antimicrobial resistance (AMR) are closely interconnected. Resistant organisms, particularly methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacterales, complicate treatment and disproportionately affect LMICs.
Broad-spectrum or prolonged antibiotic prophylaxis may further contribute to AMR. Therefore, optimizing the timing and duration of antibiotic prophylaxis, ensuring appropriate antibiotic selection and access, implementing antimicrobial stewardship (AMS), and achieving effective source control are essential.
Quality-improvement interventions demonstrate that substantial reductions in SSIs are achievable without major capital investment. Surveillance, audit and feedback, IPC champions, hand hygiene, and telecommunications technologies can strengthen accountability and support continuous improvement.
Implementation should follow the four Es (engagement, education, execution, and evaluation) to promote multidisciplinary ownership, build knowledge, standardized workflows, and monitor outcomes. Future progress requires root-cause analysis and a shift from compliance-centered models toward resilient systems that anticipate human fallibility. Emerging technologies, including real-time airborne monitoring, transcriptomic biomarkers, and thermal imaging, may enable objective continuous surveillance beyond the limitations of human assessment.
SSI prevention is both a mandatory quality-improvement measure and an ethical obligation to ensure equitable and safe surgical care. Proven IPC and AMS strategies should be complemented by next-generation surveillance and diagnostic technologies to achieve further meaningful reductions in SSI worldwide.
Reference
