Addressing an increase in surgical site infections during the COVID-19 pandemic – identifying opportunities during a chaotic time

BACKGROUND: Healthcare systems saw increases in device-associated infections and decreases in surgical site infections (SSI) during the COVID-19 pandemic. However, following an increase in SSI, an acute care hospital assessed risk and preventative factors of SSIs among patients. METHODS: A retrospective cohort study on surgeries performed between January 2020 and September 2021 analyzed associations of SSI with risk and preventive factors utilizing Chi-Square, t-tests and odds ratios. A secondary analysis was utilized to determine association of case urgency and prevention practice performance. RESULTS: There was significant difference in administration of correct perioperative antibiotic selection between SSI (78.1%) and non-SSI (86.2%) along with 2.9 greater odds of developing an SSI with incorrect perioperative antibiotics. Patients who had urgent cases were significantly less likely than elective to receive pre-operative chlorhexidine gluconate wipes (81.6%, 61.5%, respectively), correct antibiotic selection and timing (93.2%, 70.8%, respectively) and chlorhexidine/alcohol skin preparation (81.6%, 67.5%, respectively). DISCUSSION: Disruption on perioperative workflow during the COVID-19 pandemic likely resulted in an increase in SSI. Numerous opportunities were identified for focused prevention efforts. CONCLUSIONS: Next steps include implementing strategies to improve SSI prevention and establish a culture that can withstand workflow disruptions to maintain a safe environment during significant changes.