Reconceptualizing Surgical Site Infection Prevention: An Interdisciplinary Care Continuum Across Pre-Hospital to Post-Discharge Phases – A Narrative Review
Abstract
Background: Surgical Site Infections (SSIs) represent a significant burden of healthcare-associated harm, contributing to increased morbidity, mortality, and healthcare costs. Traditional prevention strategies have focused narrowly on the intraoperative period, yet contemporary understanding recognizes SSI risk as a continuum influenced by care delivered long before and after the surgical incision. Aim: This narrative review aims to synthesize evidence on a comprehensive, interdisciplinary SSI prevention pathway, analyzing contributions and integration points across Emergency Medical Services (EMS), Surgical teams, Nursing, Pharmacy, Epidemiology, and Health Administration from the pre-hospital setting through post-discharge monitoring. Methods: A comprehensive search of PubMed, CINAHL, Scopus, and Web of Science databases (2010-2024) was conducted. Keywords included "surgical site infection," "prevention bundle," and terms related to each professional domain. The included literature comprised systematic reviews, clinical trials, observational studies, and guidelines. Results: The review identifies critical, often overlooked interventions in the pre-hospital phase (EMS wound management) and post-discharge phase (patient self-monitoring). It reveals significant gaps in the coordination of SSI prevention efforts across professional silos and varying alignment between quality metrics, reimbursement structures, and evidence-based practices. Two original frameworks are presented: an Interdisciplinary SSI Prevention Continuum and a Systems Alignment Matrix for SSI Metrics. Conclusion: Effective SSI reduction requires a paradigm shift from episodic, intraoperative-focused prevention to a cohesive, patient-centered continuum of care. This demands standardized interdisciplinary protocols, integrated data systems, and financial models that incentivize collaborative prevention across all domains of the surgical journey.
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Authors
Copyright (c) 2024 Ali Mohammed Ahmed Mashlawi, Laila Ali Ahmed Faqihi, Reham Abdullah Mohammed Halwani, Maram Nasser Hassan Abu Amiriyyah, Saad Abdullah Aldosari, Mubarak Abdullah Mubarak Aldawsari, Jmaan Abdullah Jmaan Aldosary, Abdullah Ayed Nasser AlMudurra, Hamzah Shuwaier Ali Salwa, Saad Saad Buraykan, Abdulrahman Abis Khalaf Alshammari, Abdullah Mohammed Alsahman, Amal Miqad Eid Alotaibi
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