Adherence to surgical care improvement project measures and post-operative surgical site infections.
BACKGROUND
Surgical site infection (SSI) is unequivocally morbid and costly. The estimated 300,000 SSIs annually in the United States represent the second most common infection among surgical patients, prolong hospitalization by 7-10 days, and have an estimated annual incremental cost of $1 billion. The mortality rate associated with SSI is 3%, with about three quarters of deaths being attributable directly to the infection. Prevention is possible for the most part, and concerted effort has been made to limit these infections, arguably to little effect.


METHODS
Review of pertinent English-language literature.


RESULTS
Numerous risk factors for SSI and tactics for prevention have been described, but efforts to bundle these tactics into an effective, comprehensive prevention program have been disappointing. Numerous studies now demonstrate that the Surgical Care Improvement Program (SCIP), which focused on process improvement rather than outcomes, has been ineffective despite governmental support, financial penalties for non-compliance, and consequent widespread implementation.


CONCLUSIONS
Required reporting has increased awareness of the problem of SSI, but just as the complexity of SSI risk, pathogenesis, and preventions reflects the complexity of the disease, many other factors must be taken into account, including the skill and knowledge of the surgical team and promulgation of a culture of quality and safety in surgical patient care.
Section of Surgical Critical Care, Baylor College of Medicine, and Department of Surgery and Surgical Intensive Care Unit, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA. sawad@bcm.edu
Samir S
SS
Awad
D019983:Guideline Adherence; D006801:Humans; D019990:Perioperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000592:standards*; D013530:Surgical Wound Infection / Q000517:prevention & control*