Tag: healthcare-associated infections

Preventing surgical site infections: from evidence to implementation

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs) and represent a major cause of postoperative morbidity, mortality, prolonged hospitalisation, and increased healthcare costs worldwide. Closely linked to antimicrobial resistance (AMR), SSIs remain a critical patient safety issue despite the availability of robust evidence-based prevention strategies.

The persistent gap between evidence and clinical practice highlights the need to prioritise effective implementation rather than the development of new preventive measures.

SSI prevention is embedded within comprehensive infection prevention and control (IPC) programmes, which are multidisciplinary and influenced by cultural, organizational, environmental, and patient-related factors.

Healthcare workers’ knowledge, awareness, and attitudes are central to translating recommendations into daily practice, while strong leadership, governance, adequate staffing, and continuous education provide the organizational foundation for IPC effectiveness. Environmental hygiene and patient vulnerability further influence infection risk, and increasing emphasis is placed on patient engagement as an active component of prevention.

International bodies such as the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the National Institute for Health and Care Excellence (NICE), and professional surgical societies have issued comprehensive SSI prevention guidelines. However, adherence remains inconsistent across healthcare settings.

Evidence from implementation science shows that multimodal strategies, combining education, audit and feedback, standardized protocols, reminders, and performance monitoring are more effective than isolated interventions in improving compliance and reducing SSI rates.

To address these challenges, the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) proposes a multimodal, continuous improvement framework aligned with the WHO implementation cycle. The paper has been recently published in Infection and Drug Resistance.

This framework conceptualizes SSI prevention as an iterative process that includes preparation and governance, baseline assessment and action planning, contextual adaptation of evidence-based practices, promotion of safety culture and behavioral change, and continuous evaluation through surveillance and feedback.

Practical implementation tools such as locally adapted protocols, care bundles, checklists, and visual reminders support the translation of guidelines into routine clinical practice. SSI prevention bundles, composed of a limited number of high-evidence perioperative interventions, have demonstrated significant reductions in infection rates when applied consistently.

Sustainable SSI prevention depends on a strong safety culture characterized by leadership engagement, interdisciplinary collaboration, psychological safety, and shared accountability. Surveillance systems, supported by audit and feedback, enable data-driven improvement, while emerging automated surveillance technologies may further strengthen IPC capacity.

Finally, a multimodal, continuous improvement approach provides a sustainable pathway for reducing SSIs and improving surgical safety, with principles applicable to the prevention of all HAIs.

Reference

Prevention and control of healthcare-associated infections: the first principle of every antimicrobial stewardship program

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

The misuse and overuse of antimicrobials are among the main drivers in the development of drug-resistant pathogens, and the appropriate use of these precious medications is paramount to preserve them for future generations to come. However, healthcare professionals should always keep in mind that also an inadequate infection prevention and control contributes considerably to the emergence and spread of antimicrobial resistance (AMR).

AMR is closely related to healthcare-associated infections (HAIs): the management of patients with HAIs frequently requires the administration of broader spectrum antibiotic regimens due to the higher risk of acquiring multidrug-resistant organisms. For this reason, even before using antimicrobials correctly, preventing the occurrence and controlling the spread of HAIs in healthcare facilities is essential. It should be considered the first principle of an appropriate antimicrobial stewardship program in every hospital worldwide.

In a paper recently published in Antibiotics, an international working group of physicians defined the most important measures to prevent and control HAIs in hospital settings.

In this narrative review, the authors presented seven measures that all healthcare workers must know and support. They focused their attention not only on the pivotal role of hand hygiene and the prevention of HAIs, but also on the importance of an effective environmental hospital hygiene, the implementation of surveillance systems, and patients’ screening, decolonization, isolation and cohorting. Finally, they did not forget to discuss about adapting evidence-based practices to the local context, and promoting safety culture.

The authors hope that this document can contribute to raise awareness among healthcare professionals about all issues associated with HAIs, and the need to embrace a personal involvement in the strategies that can help reduce their occurrence.

Fewer microorganisms there will be in our hospitals, fewer antimicrobials we will use. Fewer HAIs will develop in our hospitals, fewer broad-spectrum antibiotics we will have to use to combat multidrug-resistant organisms.

Reference

  1. Sartelli M, Marini CP, McNelis J, Coccolini F, Rizzo C, Labricciosa FM, Petrone P. Preventing and Controlling Healthcare-Associated Infections: The First Principle of Every Antimicrobial Stewardship Program in Hospital Settings. Antibiotics. 2024;13(9):896.

A global evidence-based bundle for surgical antibiotic prophylaxis

Francesco M. Labricciosa, MD, Specialist in Hygiene and Preventive Medicine

Recommending a bundle with evidence-based measures for surgical antibiotic prophylaxis (SAP), easily applicable and helpful to improve antibiotic prescribing practices among surgeons worldwide. This is the aim of a narrative review just published in Antibiotics by Massimo Sartelli and colleagues.

Surgical site infections (SSIs) represent the most common healthcare-associated infections occurring in surgical patients. Therefore, all procedures aiming to prevent SSIs should be integrated before, during, and after surgery.

SAP is one of the most important measures to prevent SSIs. Nevertheless, many surgeons erroneously believe that SAP is peripheral to their clinical practice. But actually, surgeons play a central role in prevention SSIs.

Indeed, approximately 15% of all antibiotics in hospitals are prescribed for SAP. Using antibiotics appropriately, both for therapy and prophylaxis, is essential to improve treatment effectiveness and patient safety, reduce the risk of antibiotic-associated infections (e.g., Clostridioides difficile infection), and the selection and spread of antibiotic-resistant bacteria.

Several guidelines have been published regarding SSIs prevention, but measures stated in these guidelines are not self-implementing. Bundles are among the most used methods to adapt guidelines in local contexts, and improve acceptance and adherence to best practices.

As observed by the authors, bundles implemented as stand-alone interventions or as part of multimodal strategies were associated with decreased SSI rates.

For these reasons, an international working group of 30 physicians has been established by the Global Alliance for Infections in Surgery. The authors aimed to define a global evidence-based bundle for the appropriate SAP administration, and evaluated the evidence supporting it.

This bundle includes five different actions that may affect adequate SAP administration.

A global evidence-based bundle for surgical antibiotic prophylaxis [Adapted from Figure 1 in Ref. 1]

In administering antibiotics for any indication, including for SAP, surgeons should always be responsible for handling antibiotics with care. Indeed, inappropriate prescriptions of these precious medications, as well as poor implementation of infection prevention and control measures, are contributing to the development and spread of bacterial antimicrobial-resistance.

The authors hope this bundle can be easily applied everywhere, and help to improve antibiotic prescribing practices among surgeons worldwide.

Reference

  1. Sartelli M, Coccolini F, Labricciosa FM, Al Omari AH, Bains L, Baraket O, et al. Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle. Antibiotics. 2024; 13(1):100.