Healthcare-associated infections (HAIs), including surgical site infections (SSIs), are among the most prevalent challenges in hospital settings across the globe. SSIs, in particular, contribute significantly to postoperative morbidity and mortality, extended hospital stays, and burgeoning healthcare costs. Compounding this, while evidence-based guidelines for SSI mitigation exist, hospitals struggle to consistently adhere to these guidelines, intensifying the issues at hand.
As such, the Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections (SIMPIOS) has put together a working group dedicated to streamlining the practical implementation of these proven SSI prevention measures. SIMPIOS aims encompass bridging the knowledge-practice gap by promoting a multidisciplinary, systems-oriented approach that furnishes clinical evidence with a culture of cross-functional collaboration and safety. The framework provides a structured series of steps to foster perpetual improvements in Infection Prevention and Control (IPC) measures.
Rooted in implementation science, SIMPIOS framework emphasizes a blend of different strategies, collaboration across professional boundaries, and ongoing evaluation to stimulate persistent and effective improvements in patient safety across all stages of surgical care. HAI prevention is deemed as a key priority for healthcare systems across the globe. Adopting an IPC approach, which draws from both theoretical and pragmatic standpoints, is pivotal to support patients and healthcare workers in combating the HAIs.
It is a complex area calling for a comprehensive view integrating cultural, organizational, environmental, and patient factors, which work collaboratively to ensure the overall safety of patient care. Cultural factors are fundamentally rooted in the knowledge, awareness, and attitude of healthcare professionals towards understanding and executing preventive measures. Organizational aspects dictate the readiness of a hospital setting to implement successful IPC protocols.
Environmental factors include considerations around hygiene, ventilation, water quality, waste management, and other elements important to curb microbial proliferation. Last but not least, patient factors should also be considered, they play a significant role in shaping an integrated IPC approach, with focus on patient education, engagement, and empowerment in IPC process. Touching on the issue of SSIs, despite bacterial contamination being common in surgical wounds, only a small fraction manifests into a serious infection.
That said, surgical traumas, postoperative immunosuppressive responses and specific vulnerabilities in patients can over time, weaken the host’s immunity, creating an environment conducive for SSIs to thrive. In fighting SSIs, IPC programs have shown to significantly decrease the risk of SSIs. However, evidence remains limited in terms of cost-effectiveness.
The article underlines the importance of consistent implementation of IPC measures all through the surgical pathway. Over the years, several guidelines have been published by organizations like the WHO and the American College of Surgeons amongst others. The WHO offers 29 evidence-based recommendations which focus on simple, yet vital interventions that all healthcare workers involved in patient care should comply with.
Yet, despite having compelling evidence to support these practices, there is a considerable lack of consistent implementation in daily clinical practice. To combat this, SIMPIOS develops a framework based on continuous quality improvements in IPC, focusing on the preoperative, intraoperative and postoperative stages. Utilizing international guidelines, it introduces multimodal strategies and promotes a multidisciplinary approach all through the treatment cycle for SSIs prevention.