Introduction

Surgical site infections (SSIs) are wound infections that occur after invasive surgical procedures. Depending on the location of the wound and the level of post-operative care that the patient receives, the risk of developing an SSI can be as high as 20%,¹ although across all patients undergoing inpatient procedures in the United States, the rate of SSI occurrence is between 2% and 4%.² SSI represents one of the major causes of post-operative morbidity and mortality and frequently contributes to extended hospital stays.³ In many instances, SSIs result from cross-contamination, or the transfer of harmful microorganisms, during the procedure itself or when follow-up wound care is administered. Infections secondary to cross-contamination are usually caused by bacteria, fungi, parasites, or viruses.⁴

Mechanisms and Dangers of Cross-Contamination in Surgical Wounds

Cross-contamination of microorganisms post-operatively can occur in many ways, including^4:i

• Unsterilized medical equipment
• Coughing or sneezing
• Human contact
• Touching contaminated objects
• Unclean bedding or clothing
• Prolonged use of catheters, tubes, or intravenous lines

The dangers of an SSI that resulted from cross-contamination vary depending on patient comorbidities; however, these infections are the second most common forms of nosocomial infections accounting for an increased risk of death.⁵ Even in cases where the patient is not at risk for mortality, post-operative cross-contamination can complicate and prolong the healing process, increase patient pain and discomfort, delay discharge from the hospital, and significantly increase medical costs for the patient.

Preventing Cross-Contamination in Surgical Wounds

There are substantial benefits—both for the patient and for the health care system—in preventing cross-contamination in surgical wounds whenever possible. Strategies for successfully preventing post-operative cross-contamination include:

• Hand hygiene: Proper hand hygiene is the single most effective measure in preventing cross-contamination. Proper hand hygiene means that individuals should remove personal protective equipment used during wound care and wash hands before and after equipment removal.⁶ Alcohol-based antimicrobial gels should also be readily available and used both before and after dressing a wound by anyone who is assisting with post-operative care.
• Disinfection of equipment: Health care facilities must also be vigilant about the cleaning, disinfection, and sterilization of all equipment and materials that come into contact with a patient post-operatively. These items include all surgical instruments, medical instruments that are shared among patients, and patient equipment, such as bedding, monitors, and carts.
• Antimicrobial-impregnated discs: Antimicrobial-impregnated discs can be used to prevent central line–associated bloodstream infections.⁷ These discs are especially effective at preventing catheter-associated infections or when intravenous lines or tubes must be used for a prolonged period of time.
• Personal protective equipment: Health care providers must also be cautious about changing personal protective equipment between treating patients. Gloves should be removed as soon as dressing changes have been completed and before the provider can touch any other surface. If the provider touched anything with the gloved hand, such as a saline bottle for wound irrigation, that object should also be disinfected before it is moved to another location. Masks can prevent the spread of microorganisms through sneezing or coughing. If the provider must cough or sneeze while caring for a wound and they are not wearing a mask, they should exit the room until finished, and then properly sanitize their hands and put on new gloves.
• Single-use products: The risk of cross-contamination is high when items are shared among patients, such as tapes and adhesives used for dressings. When possible, use single-use, sealed products to ensure that they are uncontaminated.

Conclusion

Infection prevention cannot be achieved in every single instance; however, proper preventative techniques can greatly reduce the number of post-operative patients who develop SSIs. When adhered to, these measures can improve the healing environment for patients and can often lead to better patient outcomes after surgical procedures and reductions in the overall cost of post-operative care.

References

1. Pawlowska I, Ziolkowski G, Wojkowska-Mach J, Bielecki T. Can surgical site infections be controlled through microbiological surveillance? A three-year laboratory-based surveillance at an orthopedic unit, retrospective observatory study. Int Orthop. 2019;43(9):2009-2016.

2. Mana TSC, Donskey C, Carty N, Perry L, Leaper D, Edmiston CD Jr. Preliminary analysis of the antimicrobial activity of a postoperative wound dressing containing chlorhexidine gluconate against methicillin-resistant Staphylococcus aureus in an in vivo porcine incision wound model. Am J Infect Control. 2019;47:1048-1052.

3. Hussain A, Amna A, Brohi S, Nadeem F, et al. Frequency of post-operative wound contamination in Bakhtawar General Hospital, Jamshoro. J Islamabad Med Dent Coll. 2020;9(1):54-58.

4. Cherney K. Cross infection. Healthline. 2017. https://www.healthline.com/health/cross-infection. Accessed September 10, 2020.

5. Khan HA, Baig FK, Mehboob R. Nosocomial infections: epidemiology, prevention, control and surveillance. Asian Pac J Trop Biomed. 2017;7(5):478-482.

6. Nazarko L. Good hygiene when dressing wounds. Nursing in Practice. 2016. https://www.nursinginpractice.com/clinical/good-hygiene-when-dressing-w…. Accessed September 10, 2020.

7. Webster J, Larsen E, Marsh N, Choudhury A, Harris P, Rickard CM. Chlorhexidine gluconate or polyhexamethylene biguanide disc dressing to reduce the incidence of a central-line-associated bloodstream infection: a feasibility randomized controlled trial (the CLABSI trial). J Hosp Infect. 2017;96(3):223-228.