Surgical site infections (SSIs) are complications that can arise after a surgical procedure, affecting the incision or deeper tissues. They are a common concern in healthcare, potentially leading to increased hospital stays and higher medical costs, impacting patient recovery and overall health.
The Primary Culprit
The microorganism most frequently associated with surgical site infections is Staphylococcus aureus. This bacterium is commonly found as part of the normal microbial community on human skin and in nasal passages. While Staphylococcus aureus is usually harmless when residing on the skin or in the nose, it can become an opportunistic pathogen. If it enters the body through a surgical incision, it can cause various infections, ranging from mild skin problems to more severe conditions.
Why Staphylococcus aureus Dominates
Staphylococcus aureus’s prevalence in SSIs stems from several characteristics. It naturally colonizes the skin and nasal passages of a significant portion of the healthy population, with approximately 30% of individuals carrying it in their nose. This widespread presence means the bacterium is readily available to contaminate a surgical site, often originating from the patient’s own body.
Staphylococcus aureus produces various virulence factors, which are molecules that contribute to its ability to cause disease. These include toxins and enzymes that help the bacterium evade the host’s immune system and break down tissues, facilitating its spread and establishment of infection.
A significant challenge posed by Staphylococcus aureus is its ability to develop antibiotic resistance. Strains like Methicillin-resistant Staphylococcus aureus (MRSA) are resistant to many common antibiotics, making infections harder to treat. MRSA infections can lead to severe outcomes, including prolonged hospital stays and increased mortality.
Minimizing the Risk
Preventing Staphylococcus aureus-related SSIs involves a multi-faceted approach. Pre-operative patient preparation includes showering or bathing with soap before surgery to reduce the bacterial load on the skin. Antiseptic washes, such as alcohol-based chlorhexidine gluconate solutions, are used on the surgical site immediately before the incision to further disinfect the skin.
Nasal decolonization with agents like mupirocin may also be considered for patients known to carry Staphylococcus aureus.
Maintaining a sterile environment in the operating room is important. This includes strict adherence to sterile techniques by surgical teams, such as proper hand hygiene, wearing sterile gowns and gloves, and ensuring all instruments are sterilized. These measures prevent Staphylococcus aureus and other microorganisms from contaminating the surgical wound during the procedure.
Antibiotic prophylaxis, involving the administration of antibiotics before surgery, helps prevent infection by targeting common bacteria like Staphylococcus aureus. The timing of this antibiotic dose ensures effective drug levels during the highest risk period.
Proper post-operative wound care, including protecting the incision with a sterile dressing, helps prevent external contamination and supports healing.