A Detailed Review of Literature on Surgical Site Infections: Analysis

This report presents a comprehensive review of twelve published research papers on surgical site infections (SSIs), exploring the current understanding of causes, treatments, and preventative measures. The studies, including systematic reviews and observational studies, highlight the impact of SSIs on healthcare costs, patient outcomes, and mortality rates. Key findings reveal that prolonged surgery duration, non-compliance with surgical procedures, and open wound surgeries are significant risk factors. The literature emphasizes the importance of team-based care, electronic health record (EHR) surveillance, and multifaceted interventions to reduce SSI prevalence. The review underscores the need for improved training, adherence to surgical protocols, and a collaborative approach among healthcare professionals to enhance patient safety and quality of care. The research suggests that SSIs prolong hospital stays, increase medication costs, and can negatively affect the overall quality of care, emphasizing the need for renewed focus on SSI prevention and management strategies.

Running head: REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS
Review of Literature on Surgical Site Infections
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REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS 1
Review of Literature on Surgical Site Infections
Introduction
Hospital-acquired surgical site infections (SSIs) have emerged to be issues of concern in
delivery of quality healthcare services. Recent studies have found that SSIs are the major causes
of prolonged stay in hospitals after surgery. Other additional adverse impacts of SSIs are
financial costs and increased mortality rates in women undergoing caesarian delivery. Stanic,
Bojanic, Grubor, Mijovic, and Maric (2017) define surgical site infection as an infection that
occurs on the part of the body where surgery had been done. In spite of technological
developments, cases of SSIs are still prevalence in many hospitals and have adverse effect on the
patients. Different scholars have documented research work on SSI with the goal of determining
the causes, treatment, and possible interventions that could help reduce the impact of SSI on
patients. This paper reviews twelve of research published literature on SSIs to establish the
current understanding on the topic.
Research Design
Badia et al. (2017) conducted a systematic review of literature on the impact of SSIs on
quality of life and financial costs. The researchers reviewed studies on SSIs published in Spain,
France, Germany, Netherlands, Italy, and the United Kingdom. Studies were obtained from
online databases and screened to eliminate duplication. Twenty-six studies qualified for analysis.
Evidence from the Study
Evidence from the studies indicated that SSI contributed to 36% of post-surgery complications.
The study also established prolonged stay in hospitals, increase in costs of medication, and
increase in mortality rates in hospitals where SSIs were prevalent. The researchers concluded

REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS 2
that in spite of efforts to provide sustainable and affordable healthcare, SSIs have adversely
negated the efforts put in place to address the quality of care in hospitals.
Limitations of the Study
The study focused on articles published in English alone. The selection criteria did not include
studies published in other languages, which could have affected the findings from the study.
Guidelines Provided
Badia et al. (2017) recommend renewed efforts in addressing SSIs in European countries.
Considering the impact of SSIs on the cost of healthcare and overall quality of life, there is a
need for the healthcare sector to focus on SSIs to help patients that undergo surgery.
Lessons from the Study
SSIs prolong the stay in hospitals, increase in costs of medication, and raise mortality rates in
hospitals. SSIs negate the efforts put in place to address the quality of care in hospitals.
Application to practice
The study contributes to existing literature on SSIs. Since it is evident that SSIs have
adverse impact on quality of life and financial costs, the study could help in addressing the issue
of SSI in hospitals.
Cheng, Chen, Soleas, Ferko, Cameron, and Hinoul (2017) conducted a systematic
analysis of articles on SSIs published between 2005 and 2015. The researchers reviewed studies
on SSIs published in English and retrieved from PubMed, CENTRAL, and CDSR. Seventy-six
studies qualified for analysis. A similar method was used by Martin, Kaye, Knott, Nguyen,
Santarossa, Evans, Elizabeth and Jaber (2015) where 94 studies published between 1985 and
2015 were systematically reviewed. Martin et al. (2015) found diabetes as the risk factor for
SSIs.

REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS 3
Evidence from the Study
Evidence from the studies indicated that prolonged period of surgery contributed to high chances
of SSI by 89% of post-surgery complications. The study found a linear relationship between
prolonged surgery and development SSIs.
Limitations of the Study
The study focused on articles that are retrospective in nature. Retrospective studies emphasize
accuracy and could have impacted the findings from the study. Both Martin et al. (2015) and
Cheng et al. (2017) explain that the reviewed articles combined different types of SSIs in one
study, leading to a generalized conclusion.
Guidelines Provided
Both Martin et al. (2015) and Cheng et al. (2017) recommend a look into the period of surgery.
Considering the impact of SSIs on the quality of life, there is a need for the healthcare sector to
focus on the period spent on patients undergoing surgery in addition to looking at other risk
factors.
Lessons from the Study
Prolonged surgeries increase the risk of SSI complications which translate to prolonged stay in
hospitals, increase in costs of medication, and high mortality rates in hospitals. There are also
other risk factors like diabetes which contributes to SSIs Physicians should revise the length of
time spent on surgeries to minimize prevalence of SSIs.
Application to practice
The study contributes to existing literature on SSIs. Since it is evident that SSIs are
directly linked to time spent on surgeries, physicians should take into consideration the time
spent on surgeries.

REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS 4
Research Design
deOliveira and Sarmento (2017) conducted an observational study on methods of surgery
and how the surgery team dressed and adhered to surgery procedures. A total of 116 observations
were made. SSIs were linked to non-compliance with surgery procedures and recommendations
Evidence from the Study
Non-compliance with surgery procedures contribute to SSIs.
Limitations of the Study
This was an observational study which could have suffered elements of bias. The observers were
undercover researchers who could have been detected, leading to bias in findings.
Guidelines Provided
De Oliveira and Sarmento (2017) recommend training of surgery teams on compliance with
surgery requirements to tackle SSIs.
Lessons from the Study
Non-compliance with surgery procedures increases prevalence of hospital-acquired SSIs.
Application to practice
Since it is evident that SSIs are directly linked to non-compliance with surgery
procedures, further trainings could reduce the prevalence of SSIs.
Research Design
In Gillespie, Kang, Roberts, Lin, Morley, Finigan, and Chaboyer (2015), the researchers
conducted an integrative review of research literature on methods used by physicians to address
SSIs. Thirteen studies published in North America were reviewed. Team-based care reduced the
time of surgery processes, hence reducing the risk of SSIs.
Evidence from the Study

REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS 5
Team-based surgeries reduced the chances of developing SSIs.
Limitations of the Study
This was on based on secondary review of literature in North America alone. Thirteen articles
are not significant enough for making global conclusions.
Guidelines Provided
The researchers recommend team-based interventions in surgeries to reduce the prevalence of
SSIs..
Lessons from the Study
SSIs increase with negligence and prolonged surgeries.
Application to practice
Since it is evident that SSIs are directly linked to hospital environments, there is a need
for physicians to collaborate for improved surgery delivery and reduce cases of SSI.
Research Design
Grundmeier, Xiao, Ross, Ramos, Karavite, Michel, and Coffin (2018) investigated the
efficiency of EHR data on surveillance of children that had undergone surgery. 234 surgeries
were monitored.
Evidence from the Study
EHR data helps in surveying groups that have undergone surgery.
Limitations of the Study
The study focused on EHR data but did not consider the causative agents in SSIs. Additionally,
EHR surveillance is not sufficient on its own. There has to a follow-up to monitor the progress.
Guidelines Provided

REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS 6
The researchers recommend use of EHR interventions in surveillance of patients who have
undergone surgeries to reduce the prevalence of SSIs.
Lessons from the Study
EHR monitoring could improve monitoring of patients that have undergone surgeries with the
goal of reducing SSIs.
Application to practice
Since it is evident that SSIs EHR system improves monitoring of patients that have
undergone surgery, hospitals should start using EHR records to monitor patients who have
undergone surgeries.
Research Design
Mueck and Kao (2018) reviewed English literature to determine the causes of SSIs. The
literatures reviewed were obtained from online databases. Systematic review of literature sought
to establish factors responsible for SSIs.
Evidence from the Study
Evidence from the studies indicated that SSI was a multifaceted problem. The study found a
linear relationship between SSIs and prolonged stay in hospitals.
Limitations of the Study
This was a generalized study that did not address a specific problem in SSI. The findings could
not provide a specific solution due to generalized approach.
Guidelines Provided
The researchers recommend use of multifaceted interventions in identifying and addressing
causes of SSIs.
Lessons from the Study

REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS 7
SSI is a multifaceted problem that needs collaborative approach to address it.
Application to practice
There is no single acceptable method of tackling SSIs. SSIs occur as a result of
multifaceted methods that have to be addressed before conducting surgery.
Research Design
Power, Davies, Hargest, Phillips, Torkington, and Morris (2014) identified patients with wound
infections and documented them. 56 patients were identified for observation. The researchers
found that chances of developing SSI increased with open surgeries.
Evidence from the Study
Open wound surgeries increase risk of SSIs
Limitations of the Study
The study only considered infections documented in hospitals and not those away from facilities.
This could have undermined the impact of open surgeries.
Guidelines Provided
Power et al. (2014) recommend that doctors carrying out open would surgeries take maximum
interventions to address SSIs.
Lessons from the Study
Open wound surgeries increase the risk of SSI complications which translate to prolonged stay in
hospitals, increase in costs of medication, and high mortality rates in hospitals.
Application to practice
The study contributes to existing literature on SSIs. Since it is evident that SSIs increase
with open wound surgeries, physicians should take into consideration the safety of the wound
when carrying out surgeries.

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References
Badia, J. M., Casey, A. L., Petrosillo, N., Hudson, P. M., Mitchell, S. A., &Crosby, C. (2017).
Impact of surgical site infection on healthcare costs and patient outcomes: a systematic
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Cheng, H., Chen, B. P., Soleas, I. M., Ferko, N. C., Cameron, C. G., & Hinoul, P. (2017).
Prolonged operative duration increases risk of surgical site infections: a systematic
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de Oliveira, A. C., & Sarmento, G., C. (2017). Surgical site infection prevention: An analysis of
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Gillespie, B. M., Kang, E., Roberts, S., Lin, F., Morley, N., Finigan, T. & Chaboyer, W. (2015).
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Jaber, L. (2015). Diabetes and risk of surgical site infection: A systematic review and

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