Infection Risk in Sterile Operative Procedures

Tacconelli E, Müller NF, Lemmen S, Mutters NT, Hagel S, Meyer E.

Dtsch Arztebl Int. 2016 Apr 22;113(16):271-8. doi: 10.3238/arztebl.2016.0271., 04/2016.

Background: The main objective of hospital hygiene  and infection prevention is to protect patients from preventable  nosocomial infections. It was recently stated that the proper goal  should be for zero infection rates in sterile surgical procedures. In  this article, we attempt to determine whether this demand is supported  by the available literature.

Methods: We  systematically searched the Medline and EMBASE databases for studies  published in the last 10 years on the efficacy of infection control  measures and carried out a meta-analysis according to the PRISMA tool.  We used the following search terms: "aseptic surgery," "intervention,"  "surgical site infection," "nosocomial infection," "intervention," and  "prevention."

Results: 2277 articles were  retrieved, of which 204 were acquired in full text and analyzed. The  quantitative analysis included 7 prospective cohort studies on the  reduction of nosocomial infection rates after aseptic surgery. The  measures used included training sessions, antibiotic prophylaxis, and  operative-site disinfection and cleaning techniques. These interventions  succeeded in reducing postoperative wound infections (relative risk  (RR] 0.99 [0.98; 1.00]). Subgroup analyses on antibiotic prophylaxis (RR  0.99 [0.98; 1.01]) and noncontrolled trials (RR 0.97 [0.92; 1.02])  revealed small, insignificant effects.

Conclusion: A  multimodal approach with the participation of specialists from various  disciplines can further reduce the rate of postoperative infection. A  reduction to zero is not realistic and is not supported by available  evidence.