Surgical site infection. Current developments in epidemiology, risk assessment and preventive measures

Background: Surgical site infections (SSI) continue to be a highly relevant topic. However, a steady decrease in incidence has been achieved over the past decades, which can be attributed in particular to specific preventive approaches. Objectives: To summarize current epidemiological figures, risk stratification approaches and preventive measures for SSI's. Materials and methods: An extensive literature search of medical databases (MEDLINE, EMBASE, Cochrane) and official surveillance institutions (Robert Koch Institute, European Centre for Disease Prevention and Control, Centers for Disease Control and Prevention) was performed and summarized in the form of a narrative review. The focus was on epidemiology, risk assessment and preventive procedural and structural measures. Results: Epidemiologically, SSIs rank in the top 3 nosocomial infections and show a highly variable incidence between 3 and 31% in vascular surgery procedures. Risk scores (e.g., SSI Risk Score, Wounds-At-Risk) are increasingly being developed to better target interventions, but need further validation. Although a broad field of valid and evidence-based recommendations exists, the ultimate preventive benefit of some measures (e.g. antimicrobial wound irrigation before skin closure) remains uncertain. Other measures, such as the use of closed-incisional negative pressure wound therapy, now have a solid evidence base and help to prevent infections, particularly in high-risk groups.. Conclusions: Adequate identification of at-risk groups and targeted use of preventive measures can further extend the positive trend in SSI reduction to date. For this purpose, tools for risk assessment and specific preventive measures in particular need to be further rigorously validated.