Background: Surgical site infection (SSI) surveillance is an important facet of hospital infection
control processes, serving an important information-gathering function. However, emphasis
on surgical outcome improvements and hospital cost containment may engender misleading
interpretations of accumulated data unless thoughtful protocols and organized
interpretation protocols are in place
Methods: Review of pertinent English-language literature and synthesis by expert opinion
Results: For many types of operations, the lowest rate of SSI that is achievable by state-ofthe-
art prevention measures is not zero; some infections are unavoidable. Moreover, it is
flawed to assume (or assert) that all SSIs are the "fault" of the surgeon or some perceived
shortcoming of process; host factors (e.g., obesity, diabetes mellitus) may predominate in some
cases. Observational studies yield flawed interpretations (if not flawed data) in the absence
of rigid scientific protocols, courtesy of the post-hoc fallacy. Observation-mode SSI rates from
two time periods may bear no true relation one to another, even if an "intervention" occurred
in between. Furthermore, outcome data alone cannot specify which process or structure to alter
if remediation is necessary. Accurate identification of remediable flaws requires direct observation
of actual work
Conclusions: Surgeons of all specialty areas fight a continuous battle to avoid infection complications.
Complex processes of SSI prevention must be executed to perfection; even then,
SSI may occur. Unfortunately, the pursuit of near-perfect future outcomes must be modulated
using imperfect knowledge of past events
