Aseptic skin preparation: reducing the risk of surgical site infection
Abstract
Surgical site infection (SSI) is a potentially serious complication of surgery, with the consequences of infection varying from local inflammation to life threatening septicaemia. SSIs result in increased patient discomfort and client dissatisfaction due to prolonged periods of hospitalization and financial implications. Infections after surgery are often blamed on poor owner compliance or patient interference; however the patient's normal skin flora has been shown to be one of the leading causes of SSIs.
Efforts to reduce patient sources of infection are aimed at decreasing the number of bacteria on the skin prior to surgery and reducing potential bacterial contamination from within the patient during surgery. This article will focus on the former of these sources via discussion of aseptic surgical skin preparation.
All surgical wounds become contaminated by bacteria, but not all become infected. A critical level of contamination is required before actual infection occurs. Quantitatively, it has been shown that if a surgical site is contaminated with >105 microorganisms per gram of tissue, the risk of surgical site infection is markedly increased (Krizek and Robson, 1975). It has been suggested, however, that this figure may oversimplify the situation somewhat, as there are many factors involved in determining whether a level of wound contamination will result in infection (Baines et al, 2012), including the host's own level of resistance.
Bacterial contamination during a surgical procedure can originate from endogenous sources (resident flora of the patient) or exogenous sources (environmental or temporary skin contaminants). However the patient is considered the major source of contamination of the surgical wound, with endogenous staphylococci and streptococci reported as frequently cultured organisms from surgical site infections (SSIs) (Baines et al, 2012).
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