SS  Vol.6 No.8 , August 2015
SSIs in Italy: Prevention and Surveillance during the Last Five Years
Surgical site infections (SSIs) are recognized as a common surgical complication, occurring in about 2% - 5% of all surgical procedures. For this reason, it is the second most common nosocomial infection, representing the 19.6% of all infections observed in hospitalized patients and 38% of those observed among surgical patients. Among SSIs prevention strategies, surveillance has been proved to be very incisive. The most recent surveillance study carried out at a national level in Italy is SNICh protocol (National Surveillance System of Surgical Site Infections), which analyses data received from 127 Italian hospitals, from the 2009 to 2011 and the entire 2013. The only application of a surveillance strategy, observing the recommended prophylaxis protocols, brought to a reduction of SSIs: their incidence has been shown to be comparable to European or American one. Furthermore, recent studies have brought strong evidence that the development of new devices, such as dressings impregnated with silver nanoparticles or triclosan-coated sutures, is strongly connected with the reduction of incidence of SSIs. In conclusion, if common preventive techniques were applied to all surgical procedures performed in the country, about 14,000 SSIs per year could be avoided with a possible savings after three years between 50 million and EUR 175 million euro.

Cite this paper
Werra, C. , Aloia, S. , Micco, R. , Giudice, R. , Tramontano, R. , Mangani, F. , Esposito, L. and Filippo, G. (2015) SSIs in Italy: Prevention and Surveillance during the Last Five Years. Surgical Science, 6, 383-394. doi: 10.4236/ss.2015.68056.

[1]   Horan, T.C., Gaynes, R.P., Martone, W.J., et al. (1992) CDC Definitions of Nosocomial Surgical Site Infections, 1992: A Modification of CDC Definitions of Surgical Wound Infections. Infection Control & Hospital Epidemiology, 13, 606-608.

[2]   Horan, T.C., Andrus, M. and Dudeck, M.A. (2008) CDC/NHSN Surveillance Definition of Health Care-Associated Infection and Criteria for Specific Types of Infections in the Acute Care Setting. American Journal of Infection Control, 36, 309-332.

[3]   Sganga, G. (2014) Surgical Site Infections. Urologia, 81, 191-195.

[4]   CDC (2010) Data from the National Hospital Discharge Survey.

[5]   Magill, S.S., et al. (2012) Prevalence of Healthcare-Associated Infections in Acute Care Hospitals in Jacksonville, Florida. Infection Control & Hospital Epidemiology, 33, 283-291.

[6]   Magill, S.S., et al. (2014) Multistate Point-Prevalence Survey of Health Care-Associated Infections. New England Journal of Medicine, 370, 1198-1208.

[7]   European Centre for Disease prevention and Control (2013) Surveillance Report: Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in European Hospitals 2011-2012. ECDC-Stockholm.

[8]   Boni, L., Benevento, A., Rovera, F., et al. (2006) Infective Complications in Laparoscopic Surgery. Surgical Infection (Larchmt), 7, 109-111.

[9]   Chen, L.F., Anderson, D.J., Hartwig, M.G., et al. (2008) Surgical Site Infections after Laparoscopic and Open Cholecystectomies in Community Hospitals. Infection Control & Hospital Epidemiology, 29, 92-94.

[10]   Sauerland, S., Lefering, R. and Neugebauer, E.A. (2004) Laparoscopic versus Open Surgery for Suspected Appendicitis. Cochrane Database of Systematic Reviews, 4, CD001546.

[11]   Varela, J.E., Wilson, S.E. and Nguyen, N.T. (2010) Laparoscopic Surgery Significantly Reduces Surgical-Site Infections Compared with Open Surgery. Surgical Endoscopy, 24, 270-276.

[12]   Romy, S., Eisenring, M.C., Bettschart, V., Petignat, C., Francioli, P. and Troillet, N. (2008) Laparoscope Use and Surgical Site Infections in Digestive Surgery. Annals of Surgery, 247, 627-632.

[13]   Forbes, S.S., Eskicioglu, C., McLeod, R.S. and Okrainec, A. (2009) Meta-Analysis of Randomized Controlled Trials Comparing Open and Laparoscopic Ventral and Incisional Hernia Repair with Mesh. British Journal of Surgery, 96, 851-858.

[14]   Aimaq, R., Akopian, G. and Kaufman, H.S. (2011) Surgical Site Infection Rates in Laparoscopic versus Open Colorectal Surgery. The American Surgeon, 77, 1290-1294.

[15]   Jenks, P.J., Laurent, M., McQuarry, S. and Watkins, R. (2014) Clinical and Economic Burden of Surgical Site Infection (SSI) and Predicted Financial Consequences of Elimination of SSI from an English Hospital. Journal of Hospital Infection, 86, 24-33.

[16]   Lamarsalle, L., Hunt, B., Schauf, M., Szwarcensztein, K. and Valentine, W.J. (2013) Evaluating the Clinical and Economic Burden of Healthcare-Associated Infections during Hospitalization for Surgery in France. Epidemiology and Infection, 141, 2473-2482.

[17]   Roy, S., Patkar, A., Daskiran, M., Levine, R., Hinoul, P. and Nigam, S. (2014) Clinical and Economic Burden of Surgical Site Infection in Hysterectomy. Surgical Infections, 15, 266-273.

[18]   Barclay, L. (2007) Improvements Needed in Infection Control, Survey Suggests. Nursing, 28-36.

[19]   Pittet, D. (2005) Infection Control and Quality Health Care in the New Millennium. American Journal of Infection Control, 33, 258-267.

[20]   Owens, P., McHugh, S., Clarke-Moloney, M., Healy, D., Fitzpatrick, F., McCormick, P. and Kavanagh, E. (2015) Improving Surgical Site Infection Prevention Practices through a Multifaceted Educational Intervention. Irish Medical Journal, 108, 78-81.

[21]   Charehbili, A., Swijnenburg, R.-J., van de Velde, C., van den Bremer, J. and van Gijn, W. (2014) A Retrospective Analysis of Surgical Site Infections after Chlorhexidine-Alcohol versus Iodine-Alcohol for Pre-Operative Antisepsis. Surgical Infections, 15, 310-313.

[22]   Sidhwa, F. and Itani, K.M.F. (2015) Skin Preparation before Surgery: Opinion and Evidence. Surgical Infections, 16, 14-23.

[23]   Allegranzi, B. and Pittet, D. (2009) Role of Hand Hygiene in Healthcare-Associate Infection Prevention. Journal of Hospital Infection, 73, 305-315.

[24]   Capretti, M.G., Sandri, F., Tridapalli, E., Galletti, S., Petracci, E. and Faldella, G. (2008) Impact of Standardized Hand Hygiene Program on the Incidence of Nosocomial Infection in Very Low Birth Weight Infants. American Journal of Infection Control, 36, 430-435.

[25]   Apisarnthanarak, A., Singh, N., Bandong, A.N. and Madriaga, G. (2015) Triclosan-Coated Sutures Reduce the Risk of Surgical Site Infections: A Systematic Review and Meta-Analysis. Infection Control & Hospital Epidemiology, 36, 169-179.

[26]   Jung, K.H., Oh, S.J., Choi, K.K., Kim, S.M., Choi, M.G., Lee, J.H., et al. (2015) Effect of Triclosan-Coated Sutures on Surgical Site Infection after Gastric Cancer Surgery via Midline Laparotomy. Annals of Surgical Treatment and Research, 87, 311-318.

[27]   Wang, Z., Jiang, C.P., Cao, Y. and Ding, Y.T. (2013) Systematic Review and Meta-Analysis of Triclosan-Coated Sutures for the Prevention of Surgical-Site Infection. British Journal of Surgery, 100, 465-473.

[28]   Daoud, F.C., Edmiston, C.E. and Leaper, D. (2014) Meta-Analysis of Prevention of Surgical Site Infections Following Incision Closure with Triclosan-Coated Sutures: Robustness to New Evidence. Surgical Infections, 15, 165-181.

[29]   Marchi, M., Pan, A., Gagliotti, C., Morsillo, F., Parenti, M., Resi, D. and Moro, M.L. (2014) The Italian National Surgical Site Infection Surveillance Programme and Its Positive Impact, 2009 to 2011. Eurosurveillance, 19, Article ID: 20815.

[30]   Grilli, E., Parenti, M., Pan, A. and Moro, M.L. (2014) Surgical Site Infections Surveillance in Italy. Orthopaedic Intervention Year 2012—Non Orthopaedic Intervention Year 2013. ASSR Emilia-Romagna.

[31]   National Center for Prevention and Control of Diseases (CMM) (2011) National Surveillance System of Surgical Site Infections (SNICh): Protocol. ASSR Emilia-Romagna, Bologna.

[32]   Zhang, Y., Dong, J., Qiao, Y., He, J., Wang, T. and Ma, S. (2014) Efficacy and Safety Profile of Antibiotic Prophylaxis Usage in Clean and Clean-Contaminated Plastic and Reconstructive Surgery. Annals of Plastic Surgery, 72, 121-130.

[33]   Velazquez-Velazquez, J.L., Santos-Flores, A., Araujo-Melendez, J., Sanchez-Sanchez, R., Velasquillo, C., Gonzalez, C., Martinez-Castanon, G. and Martinez-Gutierrez, F. (2015) Anti-Biofilm and Cytotoxicity Activity of Impregnated Dressings with Silver Nanoparticles. Materials Science and Engineering: C, 49, 604-611.

[34]   Mihaljevic, A.L., Michalski, C.W., Erkan, M., Reiser-Erkan, C., Jager, C., Schuster, T., Schuhmacher, C., Kleeff, J. and Friess, H. (2012) Standard Abdominal Wound Edge Protection with Surgical Dressings vs Coverage with a Sterile Circular Polyethylene Drape for Prevention of Surgical Site Infections (BaFO): Study Protocol for a Randomized Controlled Trial. Trials, 13, 57.

[35]   Mihaljevic, A.L., Schirren, R., Ozer, M., Ottl, S., Grün, S., Michalski, C.W., et al. (2014) Multicenter Double-Blinded Randomized Controlled Trial of Standard Abdominal Wound Edge Protection with Surgical Dressings versus Coverage with a Sterile Circular Polyethylene Drape for Prevention of Surgical Site Infections. Annals of Surgery, 260, 730-739.

[36]   Durando, P., Bassetti, M., Orengo, G., Crimi, P., Battistini, A., Bellina, D., et al. (2012) Adherence to International and National Recommendations for the Prevention of Surgical Site Infections in Italy: Results from an Observational Prospective Study in Elective Surgery. American Journal of Infection Control, 40, 969-972.

[37]   Napolitano, F., Izzo, M.T., Di Giuseppe, G. and Angelillo, I.F. (2013) Evaluation of the Appropriate Perioperative Antibiotic Prophylaxis in Italy. PLoS ONE, 8, e79532.

[38]   de Werra, C., Donzelli, I., Tramontano, S., Perone, M. and Forestieri, P. (2005) Preoperative Control of Surgical Infections. Acta Biomedica, 76, S27-S28.

[39]   Tramontano, S., Ciccone, F., Donzelli, I., Perone, M. and de Werra, C. (2005) Postoperative Infections and the Importance of Mini-Invasive Surgery, of Surgical Technique and of Technologies in Prevention: Our Experience. Acts of the XVIII SPIGC National Congress. Minerva Chirurgica, 60, S28.

[40]   de Werra, C., Perone, M., Di Micco, R., Orabona, G., Montella, E., Galloro, G. and Triassi, M. (2009) New Materials in the Prevention of Surgical Site Infections. Acts of the CXI SIC National Congress.

[41]   de Werra, C., Schiavone, D., Di Micco, R. and Triassi, M. (2009) Surgical Site Infections in Italy. Infections in Medicine, 17, 205-218.

[42]   Di Micco, R., Del Giudice, R., Cervotti, M., De Filippo, D., Di Costanzo, A., Pagnini, F. and de Werra, C. (2013) Surgical Site Infections Prophylaxis in Obese Patient: Ertapenem Efficacy in Vivo and in Vitro. Acts of the XI IBAT National Congress, 21.