Infections in Surgery : Prevention and Management

Infections in surgery, commonly known as surgical site infections (SSIs), are complications that may occur after a surgical procedure. SSIs represent a serious problem leading to increased morbidity, mortality, and healthcare costs, highlighting the need for continued efforts to improve surgical practices and reduce their incidence.

Several factors can contribute to the development of SSIs: patient-related factors (such as obesity, advanced age, diabetes, immunosuppression, pre-existing infections etc.); preoperative preparation-related factors (such as incomplete skin antisepsis or failure to administer appropriate antibiotic prophylaxis); microbial contamination (despite sterile techniques, microorganisms can infect the surgical site); surgical procedure-related factors (duration and complexity of the surgeries); postoperative care-related factors (such as inadequate wound care or infection control measures).

To prevent SSIs, healthcare facilities implement various strategies, including: optimization of patients’ conditions before surgery; preoperative antibiotic prophylaxis; strict sterile technique; postoperative wound care; surveillance and monitoring to identify and address SSIs early, preventing their spread and complications.

Despite the evidence supporting the effectiveness of best practices, many clinicians fail to implement them, and evidence-based practices that optimize both the prevention and treatment of SSIs tend to be underused, highlighting the importance of ongoing research and improvement in surgical techniques and infection control practices.

This open access book provides a practical toolkit for surgeons and intensivists to improve their daily clinical practices in order to reduce the risk of SSIs.

Dr. Stefano Bartoli is a general and vascular surgeon who has been involved in quality and safety of care for over 30 years. He is a member of the ASL Roma 2 Infection Control Committee and has promoted events on infections in surgery. He has also participated in multidisciplinary and multiprofessional initiatives on the implementation of "care bundles" for the containment of infectious risk during hospitalization. Dr. Bartoli believes that dissemination of the culture of the good use of antibiotics should be a priority for surgeons in order to develop organizational models to help contain the risk of infection in patients undergoing surgery.

Dr. Francesco Cortese is a surgeon at the Emergency Surgery Unit of San Filippo Neri Hospital in Rome. He has postgraduate degrees in General and Emergency Surgery, Anesthesia and Intensive Care, and Infectious Diseases. He is a lecturer at the "Surgical Sepsis" and "Antibiotic Stewardship" Master's courses. He is also a consultant infection specialist at San Filippo Neri Hospital and is active in the field of surgical critical care and infections, and hospital-acquired infections. He has authored numerous papers on infections and sepsis in surgery, published many scientific articles, monographs, and book chapters, and presented reports at national and international conferences and courses. He is active in medical scientific societies and has organized numerous events. Dr. Cortese has been the coordinator of the national permanent event "Abdominal Infective Syndrome" since 2011.

Dr. Massimo Sartelli is senior consultant surgeon at the Department of General and Emergency Surgery, Macerata Hospital, AST Macerata (Italy), and a member of the Hospital Infection Control Committee. His scientific activity is documented by publications in international scientific journals. In recent years, he has devoted his updating efforts to the study of surgical infections and sepsis. He coordinated the WSES Guidelines for the management of intra-abdominal infections, for the management of skin and soft tissue infections, and for the management of C. difficile infection in surgical patients. He has designed and coordinated several multicenter prospective studies involving medical institutions worldwide, defining the epidemiological and management profiles of intra-abdominal infections. He is the founder and acting director of the Global Alliance for Infections in Surgery.

Prof. Gabriele Sganga is associate professor of Surgery at the Catholic University and Director of the Division of Emergency Surgery and Trauma at Policlinico Gemelli University Hospital in Rome. He completed his fellowship at the Shock Trauma Center in Baltimore, USA. Prof. Sganga is President of the Italian Society of Intensive Care Medicine (S.I.T.I. - I.S.I.C.) and Director of the Master's course "Surgical Sepsis" at the Catholic University. Since his graduation, he has been dealing with infections and sepsis in surgery as shown by his numerous scientific papers, monographs and book chapters, reports at national and international congresses, advisory boards, activities in medical scientific societies, and numerous events also organized at the Policlinico Gemelli University Hospital.