References
Pathway to zero surgical site infections

Abstract
Surgical site infections (SSIs) lead to patient morbidity and mortality, have a significant financial impact, and have an indirect impact on the veterinary team. Measures can be taken preoperatively, intraoperatively, and postoperatively to minimise the incidence of SSIs. Individual interventions may not be clinically or statistically significant in themselves. A care bundle approach may be used to drive down rates of SSI. The evidence base is variable and the interventions may apply differently in different healthcare settings; further high-quality veterinary-specific evidence needs to be generated. Human factors and staff culture also play a role in prevention of SSI. The recommendations made in this article come from the evidence and from an advisory board held by Ethicon.
Johnson & Johnson Animal Health organised an intensive roundtable discussion on the topic of preventing surgical site infectios (SSIs). Panel members included eight senior clinicians from small animal and equine practice and both veterinary surgeons and registered veterinary nurses were represented. Challenges associated with SSI prevention and the value of care bundles were discussed.
A SSI is a healthcare-associated infection occurring at or near the site of surgery, up to 30 days after surgery or up to 1 year if implants have been left in place (Horan et al, 2008). SSIs are further classified as superficial incisional, deep incisional, or organ/space infections; diagnostic criteria are outlined in Table 1.
Adapted from National Healthcare Safety Network (2021)
SSIs result in additional patient morbidity and mortality (Jenks et al, 2014), as well as significant additional human healthcare costs (Piednoir et al, 2021). In veterinary medicine, the estimated incidence of SSIs is between 0.8 and 18.1% for small animal surgery (Nelson, 2011) and between 5 and 30% for equine surgery (Ruple-Czerniak et al, 2013). The large variation in incidence rates can be attributed to variation in surgical procedures, surgical sites, patient populations, and an absence of a standardised surveillance methodology (Weese, 2008). In human medicine, SSIs are estimated to cost US $21 to US $34000 per case (Iskandar et al, 2019; Monahan et al, 2020). A single-centre retrospective study quantified the cost of SSIs after tibial plateau levelling osteotomy to be between CA $125 to CA $5022 per patient (Nicoll et al, 2014). Another study showed a 74.4% increase in total costs in the event of an SSI (Espinel-Rupérez, 2019).
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