Reducing surgical site infections: prioritising change in Australian and New Zealand healthcare

Prevention of surgical site infections (SSIs) continues to be one of the most important issues facing all healthcare professionals. If a patient contracts an infection it can have a devastating effect on their life, something healthcare professionals are desperate to avoid, yet it remains an ongoing problem despite our best efforts.

Healthcare-associated infections are the most common hospital-acquired complication in Australian hospitals.¹ Sutures, like all implanted materials, increase the probability of SSI,² an important consideration because 67% of SSIs are confined to the incision.² From an Australian perspective, SSIs adversely affect tens of thousands of patients each year and place an additional economic burden on the Australian national healthcare system.³ Post-surgery infections can cause significant harm and result in increased hospital stays, re-admissions, and re-operations, with each additional hospitalisation resulting in approximately A$42,102 in extra costs.¹ Nevertheless, more than half (55%) of SSIs are avoidable, when infection control measures are complied with and adequate prevention guidelines are adopted.^4,5

Prevention is absolutely still the key. The suture material used to close a wound can have a huge effect on the risk of infection, a concept that is not always recognised or widely promoted. However, one of the more innovative solutions already making a difference in clinical outcomes is the introduction of antibacterial sutures. Absorbable sutures with antibacterial protection are recommended for use as part of a bundle of care for preventing SSIs in wound closure after a surgical procedure.⁶

Using triclosan-coated sutures, as part of a bundle of care approach, can help reduce the risk of developing SSIs by 28%,⁷ from the meta-analysis study by de Jonge et al. (21 randomised controlled trials (RCT), 6462 patients, 95% CI: (14, 40%), P < 0.001). All triclosan-coated sutures in these RCT were Ethicon Plus Antibacterial Sutures (MONOCRYL™ Plus, VICRYL™ Plus, and PDS™ Plus). It is notable that Johnson & Johnson MedTech is driving the adoption of coated sutures by deciding to withdraw all non-antibacterial sutures from the Australian and New Zealand markets, effective 1 August 2024, in cases where they can be replaced with an antibacterial alternative. Prioritising this change and committing to using antibacterial sutures as part of a bundle of care approach in Australian hospitals has the potential to significantly reduce SSI infections, thereby improving patient care and clinical outcomes.