Background: Surveillance of surgical site infection (SSI) is one of the most effective methods
for decreasing the incidence. We determined the risk factors for SSI and the effect of a one-year
surveillance program on the rate at a tertiary-care center.
Methods: The annual SSI rate before the study period was determined in a preliminary
study. Risk factors related to SSI, the bacteria cultured from infected sites, and the effect of
surveillance were then analyzed prospectively. Risk factors were determined by logistic regression
analysis, and 95% confidence intervals were calculated.
Results: The incidence of SSI decreased from 12.8% before the study to 8.8% at the end of
the surveillance period. There were 90 SSIs (8.8%) in 1,017 procedures during the study period,
most of which (77; 69%) were detected during the hospital stay. The distribution of superficial
incisional, deep incisional, and organ/space SSI was 61.1%, 33.4%, and 5.5%, respectively.
Prolonged preoperative hospital stay (>8 days), abdominal incision, early
preoperative hair removal, inappropriate antimicrobial prophylaxis, whole blood transfusion,
famotidine treatment, repair with mesh, age >75 years, wound contamination, high American
Society of Anesthesiologists score, malnutrition, diabetes mellitus, emergency surgery,
obesity, and coexistent infection proved to be independent risk factors for SSI, whereas the
skin closure technique, patient sex, presence of malignancy, smoking history, and duration
of operation were not.
Staphylococcus aureus and Escherichia coli were the bacteria isolated most frequently. Six
infected patients (5.4%) died, four because of SSI. Development of SSI increased hospital expenses
by around US$600 per patient.
Conclusion: Surveillance even for one year decreases the incidence of SSI.
