Infections Prevention in Surgical Oncology

Despite recent advances in evidence-based guidelines and antibiotic therapy, surgical site infections, or SSIs, after oncologic surgery remain one of the most frequent postoperative complications (Funahara et al., 2017). These healthcare-associated infections are a substantial burden to the healthcare system in terms of patient mortality, morbidity, and additional costs. The reasons for the high incidence of such infections are multifactorial, which implies that there is a need for the integration of preventive measures before, during, and after surgery. Taking into account that cancer patients are immunocompromised, infection control strategies become a fundamental part of high-quality oncologic care (Ariza-Heredia & Chemaly, 2018). Drawing upon recent evidence, this paper discusses the problem of surgical site infections in surgical oncology units and suggests a solution to reduce this issue and the consequences associated with it.

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In modern healthcare, SSIs reflect an important complication threatening the patient’s quality of life. Because the surgical site serves as a potential entry for exogenous organisms, it poses an immediate threat to the patient’s body, and infections, in turn, lead to prolonged wound healing (Purba et al., 2018). Even though SSIs have been recognized as one of the most preventable complications, they continue to occur at an unacceptable rate and remain the most frequent postoperative issue leading to increased patient morbidity and mortality (Badia et al., 2017). Additionally, SSIs have a substantial impact on the hospital treating the patient due to prolonged hospitalization and increased healthcare expenditures. For instance, deaths among cancer patients who develop an SSI are directly attributable to the infection in almost 80% of cases (Bakkum-Gamez & Dowdy, 2017). The management of SSIs costs up to $10 billion annually (Bakkum-Gamez & Dowdy, 2017). Thus, it is imperative to monitor the rate of SSIs as a marker of safety and quality of surgical patient care.

Currently, greater awareness has occurred of the significance of danger that SSIs pose (Taylor et al., 2016). Prevention programs aimed at reducing SSIs have been implemented that require the integration of a range of measures before, during, and after surgery. However, there have been identified numerous gaps in evidence-based guidance, which negatively influences the practice of medicine and overall quality of care (Allegranzi et al., 2016). Despite the existing inconsistencies in guidelines, there exist interventions that have proven to be effective in reducing SSIs in surgical oncology. One of such methods is an SSI prevention bundle that includes: preoperative chlorhexidine shower, normothermia, glycemic control, prophylactic antibiotics, and a separate closing tray. As suggested, this prevention bundle successfully decreases SSIs in patients undergoing cancer surgery, thus improving the overall quality of care (Nguyen et al., 2019). Therefore, there is a pressing need to promote the wide implementation of SSI prevention bundles in oncology patients to reduce postoperative SSIs and the severity of consequences associated with these infections.

To conclude, SSIs are currently considered as one of the most common and preventable complications developed in patients after oncologic surgery. However, despite the advances made, these infections continue to occur at an unacceptable rate, leading to increased patient mortality and morbidity, and healthcare expenditures. Even though there have been developed measures aimed at reducing the rate of SSIs, there exist numerous gaps in evidence-based guidance. Despite these issues, SSI prevention bundles have been recommended as effective in decreasing SSIs in patients undergoing cancer surgery. Hence, their implementation should be widely promoted to reduce postoperative SSIs, consequently improving the overall quality of patient care.

References

Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N. Z., Zayed, B., Gomes, S. M… The WHO Guidelines Development Group. (2016). New WHO recommendations on preoperative measures for surgical site infection prevention: An evidence-based global perspective. The Lancet, 16(12), 276-287.

Ariza-Heredia, E. J., & Chemaly, R. F. (2018). Update on infection control practice in cancer hospitals. CA: A Cancer Journal for Clinicians, 68(5), 340-355.

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 review in six European countries. Journal of Hospital Infection, 96(1), 1-15.

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Bakkum-Gamez, J. N., & Dowdy, S. C. (2017). Improving surgical site infection rates through continuous quality improvement. Annals of Surgical Oncology, 24(2), 305-307.

Funahara, M., Yanamoto, S., Michihiro, U., Suzuki, T., Ota, Y., Nishimaki, F… Umeda, M. (2017). Prevention of surgical site infection after oral cancer surgery by topical tetracycline. Medicine, 96(48), e8891.

Nguyen, J. M. V., Sadeghi, M., Gien, L. T., Covens, A., Kupets, R., Nathens, A. B., & Vicus, D. (2019). Impact of a preventive bundle to reduce surgical site infections in gynecologic oncology. Gynecologic Oncology, 152(3), 480-485.

Purba, A. K. R., Setiawan, D., Bathoorn, E., Postma, M. J., Dik, J. W. H., & Friedrich, A. W. (2018). Prevention of surgical site infections: A systematic review of cost analyses in the use of prophylactic antibiotics. Frontiers in Pharmacology, 9.

Taylor, J. S., Marten, C. A., Potts, K. A., Cloutier, L. M., Cain, K. E., Fenton, S. L… Schmeler, K.M. (2016). What is the real rate of surgical site infection? Journal of Oncology Practice, 12(10), 878-883.

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