Surgical Site Infections


Surgical site infections (SSIs) occur after surgery in the part of the body where the surgery took place. These infections may involve only the skin, or may be more serious and involve tissue under the skin or organs. SSIs sometimes take days or months after surgery to develop so it is important to track patients after discharge for a period of time to assure that no infection has occurred.

Some patients may be at higher risk for developing a SSI due to age, underlying medical conditions, invasiveness of the surgery itself, duration of procedure, or other factors. It is important that both the patient and the healthcare providers take the appropriate steps to help prevent an infection.

Symptoms of a SSI may include:

  • Fever
  • Redness and/or pain around the surgical site
  • Drainage of cloudy fluid from the surgical wound

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Estimated burden of SSIs in acute care facilities in the United States:

  • Morbidity
    • Most common type of HAI (22% of all infections).
    • An estimated 157,500 SSIs per year (all procedures) with 66,100 attributed to Surgical Care Improvement Project (SCIP) procedures. (citation)
    • According to the latest CDC National and State HAI Progress Report, in 2014, acute care hospitals experienced a 17% reduction in SSIs compared to 2008.
      • Virginia hospitals experienced a 20% decline in abdominal hysterectomy SSIs and a 10% decline in colon surgery SSIs between 2008 and 2013.
    • 2%-5% of patients undergoing inpatient surgery develop a SSI. (citation)
    • Each SSI is associated with approximately 7-10 additional postoperative hospital days. (citation)
  • Mortality
    • 3% mortality. (citation)
    • 2-11 times higher risk of death compared with operative patients without a SSI. (citation)
    • 77% of deaths among patients with SSI are directly attributable to SSI. (citation)
    • Over 8% of the HAIs that were associated with deaths in the US were SSIs. (citation)
  • Costs (citation)
    • Estimated cost per infection ranges from $11,000 – $35,000
    • Estimated total cost in the United States ranges from $3 billion – $10 billion annually
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In January 2012, the Centers for Medicare and Medicaid Services (CMS) began requiring acute care hospitals participating in their Hospital Inpatient Quality Reporting Program to report SSIs following colon surgery and abdominal hysterectomy procedures. These data are publicly available on Hospital Compare.

In September 2015, the VDH reporting regulations were updated to align state reporting requirements with the CMS Hospital Inpatient Quality Reporting Program. Under the new regulations, hospitals are reporting SSI following colon and abdominal hysterectomy procedure data to VDH through the National Healthcare Safety Network (NHSN). For more information on these data and the state regulation mandating their reporting, please see Public Reporting Page.

VDH HAI Program activities to address this issue:

  • SSI surveillance pilot (June 2010 – August 2011): Voluntary project in 18 hospitals to pilot test surveillance on coronary artery bypass graft (CABG), hip replacement, or knee replacement surgical procedures using NHSN definitions and software. Included training on definitions, conference calls with participants to discuss surveillance challenges, promotion of working with IT departments to automate data upload to NHSN, and measurement of time and effort for surveillance. Data on SCIP procedures related to antibiotic use (appropriate antibiotic, appropriate timing of antibiotic, and appropriate discontinuation of antibiotic) also collected. Most of the participating hospitals found it helpful in preparing for SSI reporting through NHSN required by CMS.
    • Surgical site infection (SSI) surveillance pilot project, data presentation collaborative, and SSI mini-grant report
  • SSI mini-grant program (June 2011 – November 2011): Disseminated funds to 22 hospitals to assist with implementation of the NHSN Procedure-Associated Module to help hospitals prepare for CMS reporting of colon surgeries and abdominal hysterectomies. Examples of grant recipient activities included programmer support to create electronic files to upload surgical procedure data, surveillance staff training, and modification of internal systems.
    • Surgical site infection (SSI) surveillance pilot project, data presentation collaborative, and SSI mini-grant report

Prevention Strategies for Healthcare Providers

To prevent SSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:

  • Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery.
  • Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient.
  • If indicated, remove some of the patient’s hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur.
  • Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.
  • When indicated, give the patient antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery.
  • Clean the skin at the site of the surgery with a special soap that kills germs.

SHEA/IDSA Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals – SSI

CDC SSI toolkit for hospitals – contains background on epidemiology of SSIs as well as core and supplemental prevention strategies

WHO Surgical Safety Checklist – tool for use by clinicians to improve the safety of their operations and reduce surgical deaths and complications.  Applicable for national and international settings.

Tools and Resources

AHA/HRET Hospital Engagement Network 2.0 – change package, improvement strategies, checklist, and other resources

APIC Guide to the Elimination of Orthopedic Surgical Site Infections, 2010

Guideline for Prevention of Surgical Site Infection, 1999

NHSN Procedure-Associated Module: protocol, training, forms, analysis resources, and support materials – click on the appropriate healthcare setting and select the SSI link to access the materials

SHEA Patient Education Guide (SSI) – fact sheet that educates patients and their families about 7 types of HAIs (including SSIs) and how to work with healthcare professionals to prevent them.

Consumer tips for safe surgery

For more patient resources, please see the Consumer and Public Information page or go to the CDC SSI website.

Magill SS, Edwards JR, Bamberg W, et al. Multistate Point-Prevalence Survey of Health Care–Associated Infections. N Engl J Med 2014;370:1198-208. To access the full article, link through this website: (click top link)