There are an estimated 157,500 surgical site infections (SSI) annually in the U.S., costing 3.3 billion dollars (CDC, 2019)1. Postoperative infections contribute to increased morbidity, extended hospital stays, and higher mortality. Half of SSIs are believed to be preventable. Ambulatory Surgical Centers (ASCs) have a lower SSI rate than inpatient facilities. An analysis by the California Ambulatory Surgery Association of 1,000,000 surgeries performed between 2015 and 2016 found that the rate of SSIs in ASCs was six times lower than in hospital settings; even high-risk specialty infection rate was under 0.7% (Wilson, 2017)2. Ambulatory surgery centers must prioritize transparency and accountability in their reporting. This requires rigorous monitoring and strict adherence to infection protocols and procedures. Some ASCs are more effective than others at tracking and preventing SSIs. The following are strategies to help your ASC stay out of the statistics.

Infection Prevention Team

A well-educated and motivated staff is the foundation for success. Having a dedicated infection preventionist in the ASC is essential for ensuring compliance. The Association of periOperative Registered Nurses (AORN) Ambulatory Surgery Division recommends that ASCs follow regulatory requirements through the ASC Academy Infection Prevention Control Online program. This evidence-based program is specifically designed to help ASCs meet regulatory standards. Equally important is ensuring that ASC staff feel supported by the administration and take pride in their role in infection prevention.

Trusted Sources

Additional trusted resources for SSI surveillance include the CDC’s National Healthcare Safety Network (NHSN) and the Outpatient Procedure Component (OPC), which specifically tracks SSIs in ASCs, helping to identify the true infection burden. The National Surgical Quality Improvement Program (NSQIP), CDC guidelines, World Health Organization (2016), Comprehensive Unit-Based Safety Program (CUSP), and the Joint Commission are other valued guidelines. 

Robust monitoring and feedback mechanisms are crucial. Key practices such as hand hygiene and proper use of personal protective equipment should be regularly audited. The infection control team should also monitor adherence to preoperative patient practices, including patient preparation, nasal decolonization, thermoregulation, hair removal, mechanical bowel preparation, and prophylactic antibiotic administration. A feedback system is vital for reinforcing best practices and identifying areas for improvement. Providing surgeons with regular SSI updates also reduces SSIs. All healthcare staff need to understand that the primary goal of tracking is to prevent future SSIs, not to impose penalties.

Timing and Optimization

Consider the timing of surgery to other ongoing treatments that could affect postoperative healing. Most outpatient surgeries are elective, allowing for greater control over surgical timing. Factors such as immunosuppressant therapy, cancer treatment, existing infections, and nutritional status should be carefully evaluated. Even increased anxiety and a lack of a support system can negatively impact a patient’s metabolic response to surgical stress. Scheduling surgeries during these vulnerable periods may elevate the risk of SSI.

Optimization discussions should occur well before surgery. Smoking, for instance, increases the risk of SSI and other adverse outcomes, and cessation is advised at least 4–6 weeks before surgery and continued in the postoperative period. Proper glucose management and maintaining a stable A1c level can reduce the risk of delayed wound healing and complications. Patients who understand the importance of taking care of themselves pre- and postoperatively are more likely to have a successful surgical outcome. 

Preventing SSIs should be a top priority for all ASCs. Investing in a dedicated infection control team and equipping staff with evidence-based resources tailored to the ASC environment is critical for success. Assessing the patient’s current health status is fundamental to minimizing the risk of postoperative complications. With the right focus and investment, your facility can excel in patient care and infection prevention, avoiding the pitfalls of becoming an SSI statistic.

References

1. Centers for Disease Control and Prevention (2019) NHSN Surgical Site Infection Surveillance. Retrieved from https://www.cdc.gov/nhsn/pdfs/training/2019/ssi-508.pdf 

1. Wilson, T. (2017), Benchmarking study of 1,000,000 surgeries in ASCs demonstrates minimal surgical site infections, emergency department visits and readmission rates, Becker’s ASC Review, Retrieved from https://www.beckersasc.com/asc-news/benchmarking-study-of-1-000-000-surgeries-in-ascs-demonstrates-minimal-surgical-site-infections-emergency-department-visits-and-readmission-rates.html 

1. Anderson, D., & Sexton, D. (2024) Overview of control measures for prevention of surgical site infection in adults. Retrieved from https://www.uptodate.com/contents/4044 

1. AORN (2024). Perioperative solutions in the outpatient setting. Retrieved from https://www.aorn.org/docs/default-source/education/asc/asc-brochure-081224.pdf?sfvrsn=3f4fd429_12