BC Patient Safety & Quality Council

Surgical Site Infections

Our challenge

Health care in British Columbia and Canada continues to struggle with surgical site infections (SSI). Surgical site infection is the most common health care-associated infection among surgical patients.

U.S. literature confirms that 77%1 of patient deaths are reported to be related to infection, and infections result in 3.7 million excess hospital days and $1.6-3 billion in excess hospital costs per year.2,3

Despite advances in aseptic technique, antibiotic prophylaxis, and less invasive surgical techniques, healthcare associated infections (HAI) continue to complicate the recovery of many surgical patients.

International guideline setting bodies (NICE, SHEA, CDC, WHO, and relevant research literature published after these guidelines) have outlined the importance of implementing appropriate antibiotics prophylactically, antiseptic prophylaxis, hair removal, glucose control and perioperative normothermia to reduce surgical site infections.

Despite large-scale awareness campaigns in both Canada and the U.S. (Safer Healthcare Now!, Institute for Healthcare Improvement, Surgical Care Improvement Program and Surgical Care Outcomes Assessment Program), along with Accreditation Canada’s guidelines stipulating antibiotic timing and tracking SSI, generalized uptake varies greatly among our health care institutions.

The Clinical Care Management initiative has outlined a clear commitment to improved patient care and a reduction in surgical site infections. There are currently 22 hospitals in British Columbia participating in a rigorous, outcome-based, risk-adjusted measurement platform; however, many smaller sites are not part of this program. Despite this, all hospitals have responsibility to implement antibiotic timing and tracking of SSI rates. Note that the measurement aspect will only focus on antibiotic timing and SSI rates.

There are other variables, beyond these four care components, which may affect SSI rates, such as: OR staff scrubbing technique, OR doors opening/closing, air quality, nutrition, and perioperative hyperoxia.

  1. Mangram A, Horan T, Pearson M, Silver L, Jarvis W. The Hospital Infection Control Practices Advisory Committee: Guidelines for prevention of surgical site infection. Infect Control Hospital Epidemiol 1999;20:247-80.
  2. Kirkland K, Briggs J, Trivette S, Wilkinson W, Sexton D. The impact of surgical-site infections on the 1990s: Attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725-30.
  3. Martone W, Nichols R. Recognition, prevention, surveillance, and management of surgical site infections: Introduction to the problem and symposium overview.
    Clinical infectious Diseases 2001;33:S67-8

At a Glance

Key Contacts:

Ron Collins:
Clinical Advisor

Ross Hayward,
Director, Quality Analysis and Clinical Consultation
BC Ministry of Health
250 952-1188