Hygiene FAQs

Here you will find the most important facts about hospital hygiene in categories at a glance. We are constantly working on providing new information for you.

Surgical Site Infections

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What are surgical site infections?

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material.

What are possible causes and risk factors of surgical site infections?

The most common germs causing SSIs are the bacteria Staphylococcus, Streptococcus, and Pseudomonas. Germs can infect a surgical wound through various forms of contact, such as from the touch of a contaminated person or surgical instrument, through germs in the air, or through germs that are already on or in the body and then spread into the wound.

How long after surgery is there a risk of infection?

A surgical wound infection can develop any time from two to three days after surgery until the wound has visibly healed (usually two to three weeks after the operation). Very occasionally, an infection can occur several months after an operation.

How are surgical site infections treated?

Most surgical site infections can be treated with antibiotics. The antibiotic depends on the bacteria causing the infection. Sometimes patients with SSIs also need another surgery to treat the infection.

Why should antibiotics be used before surgery, but not afterwards?

There is evidence showing that antibiotics given at a set time before surgery will usually prevent infections (prophylaxis). However, there is no evidence that using antibiotics for prophylaxis after surgery prevents infection in any way. In fact, it may even be harmful by contributing to the development of antibiotic resistance. Antibiotics should only be used after surgery to treat infections, not to prevent them.

How important is hand hygiene in the context of SSI prevention?

To prevent SSIs, doctors, nurses, and other healthcare providers should clean their hands and arms up to their elbows with an antiseptic agent just before the surgery and clean their hands with alcohol-based hand rub before and after caring for each patient.

What should patients consider before surgery?

Patients should ask the doctor what they can do to reduce their risk for a surgical site infection. The most important things are to stop smoking and to avoid shaving in the skin area that the surgeon is planning to operate through. The surgical team should be informed about the medical history, especially if the patient has diabetes or another chronic illness.

How can patients help to prevent a surgical site infection after surgery?

After surgery the patient should follow the doctor’s instructions about wound care. If the patient develops a fever or pus, redness, heat, pain or tenderness near the wound or any other signs or symptoms he/she should inform the doctor immediately.

Patients should make sure that doctors, nurses, friends and family members disinfect their hands before and after they enter the room.



(c) freepik

What are hospital-acquired infections?

As the name implies, acquired infections are transmitted in hospitals or other healthcare facilities such as rehabilitation centres or nursing homes, where the patient’s immune system is weak and more sensitive to infections. HAI often occur in intensive care units. Therefore, they are also referred to as health care-associated infections (HCAI), because they do not only present themselves in hospitals.

One in 10 patients is infected with HAI. It is more common in developing countries, and more than 40% of hospital stays in Latin America and Asia lead to HAI. This is associated with costs and increased mortality.

How are H(C)AI transmitted? 

Infections can be acquired outside the healthcare facility, caused by other patients, nurses or even the patient’s own skin, if the microorganism breaks through the skin barrier. There are several ways to transmit HAI. For example, via laundry, air, contaminated equipment, personnel or – as mentioned above – the patient’s own skin.

The most common transmission is direct contact or droplets that change the host by talking or sneezing and coughing. Microorganisms transmitted by air are Legionella, Mycobacterium tuberculosis, Rubella and Varicella. They can travel long distances because they are carried by the air stream and then accidentally inhaled by another person. But there are also contact infections caused by equipment, apparatus or other people and by infectious food via the gastrointestinal tract. Insects can carry microorganisms, too.

How can H(C)AI be detected?

Symptoms vary from type to type, but usually a patient develops SSI, meningitis, pneumonia or urinary tract infections. HAI can also cause fever, shortness of breath, headaches, diarrhoea, nausea and leakage of wound secretion.

How are H(C)AI treated?

There are two infections that patients usually suffer from: Gram-positive strains of MRSA (methicillin-resistant Staphylococcus aureus) and gram-negative Acinetobacter baumannii. While MRSA is quite easy to treat, only a handful of effective antibiotics are available to treat Acinetobacter baumannii. In the worst case, infected persons have to be isolated in order to prevent further infection.

How can H(C)AI be prevented?

Irrespective of the type of infection, it is recommended to take QA/QC measures, continuously monitor air quality in the premises, hygiene protocols and guidelines for sterilization of instruments, hand hygiene, surface cleaning and the use of antibiotics, alcoholic rub-in preparations and hot water treatment. These steps can reduce the risk of HAI by 70%.

To cut a long story short: the answer is hospital hygiene.

Patients should be encouraged to inform staff of any complaints and symptoms. Staff and, in certain cases, visitors should also be encouraged to disinfect their hands properly.

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