Healthcare-associated infections (HAIs) result in significant patient morbidity and can prolong the duration of the hospital stay, causing high supplementary costs in addition to those already sustained due to the patient’s underlying disease. Moreover, bacteria are becoming increasingly resistant to antibiotics, making HAI prevention even more important nowadays. The public health consequences of antimicrobial resistance should be constrained by prevention and control actions, which must be a priority for all health systems of the world at all levels of care. As many HAIs are preventable, they may be considered an important indicator of the quality of patient care and represent an important patient safety issue in healthcare. To share implementation strategies for preventing HAIs in the surgical setting and in all healthcare facilities, an Italian multi-society document was published online in November 2022. This article represents an evidence-based summary of the document.

Appropriate measures of infection prevention and management are integral to optimal clinical practice and standards of care. Among surgeons, these measures are often over-looked. However, surgeons are at the forefront in preventing and managing infections. Surgeons are responsible for many of the processes of healthcare that impact the risk for surgical site infections and play a key role in their prevention. Surgeons are also at the forefront in managing patients with infections, who often need prompt source control and appropriate antibiotic therapy, and are directly responsible for their outcome. In this context, the direct leadership of surgeons in infection prevention and management is of utmost importance. In order to disseminate worldwide this message, the editorial has been translated into 9 different languages (Arabic, Chinese, French, German, Italian, Portuguese, Spanish, Russian, and Turkish).

Background: Surgical site infections (SSI) are among the most frequently observed healthcare associated infections and represent a significant target to reduce the impact of antimicrobial resistance. Use of a surgical care bundle has demonstrated efficacy in reduction in SSI, but there is a lack of consensus on which elements should be included within such a bundle. The aim of this international consensus was to determine what factors should be utilized to produce an optimal, evidence-led bundle of care that can be utilized in a multidisciplinary manner across specialties and across countries. Methods: The process employed a modified Delphi methodology. Based on published high-level evidence an international multidisciplinary steering group developed 38 statements for testing with a wider responder panel of healthcare professionals in Europe. The threshold for consensus agreement was set at 75%. Results: A total of 820 responses were analyzed, with the majority of participants being surgeons (59%) and nurses (19.1%) from across Europe. The consensus process evaluated 36 finalized statements covering preoperative, intraoperative, and postoperative SSI prevention practices. Overall, 33 out of 36 statements (92%) reached the predefined consensus threshold of 75% agreement. A high agreement was observed across multiple roles and specialties, although some variation existed for specific topics such as antiseptic irrigation, use of antimicrobial sutures, and plastic adhesive drapes. Conclusion: This large consensus of European HCPs involved in the surgical care of patients achieved strong levels of consensus across most of the proposed statements on elements of an SSI prevention bundle. These practice recommendations could be adopted as an evidence- and expert-based care bundle for the prevention of SSI. The project was registered at www.researchregistry.com.

Prosthetic infection is a major concern in surgery. The global epidemiology is difficult to be defined and the incidence is generally underestimated due to the lack of surveillance. A better knowledge of prosthetic infections and a greater understanding of their pathophysiology and risk factors is necessary to implement perioperative measures to prevent this major complication.

Patients with medical devices or who undergo surgical procedures are at risk for healthcare-associated infections. Surgical site infection (SSI) is the most common healthcare-associated infection and continues to be a major clinical problem in terms of morbidity and mortality, length of hospital stay and financial cost. Guidelines for the prevention of SSIs support healthcare workers in averting infections, by focusing also on control programs regarding both surgical safety and antimicrobial resistance. However, despite the clear evidence and the guidelines, their application in infection, prevention and control is uniformly poor. We therefore suggest the adoption of evidence-based recommendations in clinical practice to improve infection control, by considering its multidimensional aspect.

Approximately 250 million surgical procedures are performed worldwide every year. Most of these procedures lead to good results and an improvement in patient health, but unfortunately not all have such positive outcomes. Surgical site infections (SSI) have a significant clinical and economic impact. SSIs could be prevented by adopting adequate surveillance systems and prevention programs. These programs can contribute to increase awareness of the risk factors and possible improvement actions through the reporting and careful assessment of all infections related to care and therefore subject to reporting and analysis with audits of significant events or mortality and morbidity review. Infection prevention and control can further develop formative peer assessment of infection prevention practices and evaluation control according to clear and measurable standards by management. Clinical surveillance and advanced epidemiological investigations with the support of state-of-the-art information technology systems make it possible to promptly alert healthcare professionals and management to the presence of a case of healthcare-associated infection or an emerging germ and to analyze trends at a territorial or organizational level.