Table 3. Characteristics of the 11 studies included in the meta-analysis.
| Reference | N | Study design | Nature of surgery | Intervention | SSI (incidence) before intervention | SSI (incidence) after intervention |
|---|---|---|---|---|---|---|
| (16) | 1088 | Prospective cohort study |
Orthopedic procedure |
Setting up a team of hygiene specialists to promote adherence to surgical infection prophylaxis specified in standard operating procedure (SOP), with regular feedback | 3.3% | 2.0% |
| (17) | 811 | Prospective cohort study |
Abdominal surgery | Intervention 1: Daily requirement to justify need for an indwelling catheterIntervention 2: Intervention 1 plus sterile intraoperative catheter placement | 6.9% | Intervention 1: 2.7% Intervention 2: 0.8% |
| (13) | 1001 | Retrospective cohort study |
Coronary arterial bypass with sternotomy |
Implementation of intra- and postoperative prevention practices | 3.0% | 0%*1 |
| (19) | 1616 | Prospective cohort studies over two time periods |
Cesarean section | Before intervention: Prophylactic antibiotics only for elective sectionIntervention: Prophylactic antibiotics for all patients, supplemented by education of medical personnel in aseptic and scrub techniques | Elective C sections: 5.3% Wound infections: 4.5% |
Elective C sections: 0.9% Wound infections: 1.5% |
| (15) | 60 460 | Prospective cohort study |
Abdominal and chest surgery | Implementation of a surveillance program | 2.6% | 0.7%*2 |
| (21) | 192 | Prospective cohort study |
Abdominal hysterectomy | Education of personnel in antibiotic prophylaxis Change: From povidone-iodine solution to 4%chlorhexidine solution preoperatively |
10.7% | 1.2% |
| (11) | 3496 | Prospective cohort study (before/after study) |
All forms of surgery | Education of personnel in antibiotic prophylaxis for sterile surgery, followed by prospective observation | 3.2% | 1.9% |
| (14) | 3621 | Prospective cohort study (before/after study) |
Vascular, abdominal, gynecological, and orthopedic surgery | Optimization of SOPs for preoperative antibiotic prophylaxis | 5.3% | 4.5% |
| (18) | 12 299 | Prospective cohort study |
All forms of surgery | Single-dose antibiotic prophylaxis instead of 24-h regimen | 2.1% | 2.1% |
| (12) | 618 | Randomized controlled clinical trial |
Local excisions, mastectomy, and microdochectomy | Single dose of flucloxacillin vs. no antibiotic prophylaxis | 3.2% | 4.5% |
| (20) | 2338 | Prospective cohort study |
Surgery for breast cancer | Implementation of enhanced infection control measures | 33.3% | 18.9% |
| (23) | 341 | Retrospective cohort study |
Aseptic revision knee arthroplasty | Short antibiotic prophylaxis vs. extended antibiotic prophylaxis (5days postoperatively) | 6.9% | 2.2% |
| (22) | 2301 | Retrospective or prospective | General surgery | Implementation of hand hygiene | 5% | 6.5% |
*1All procedures were carried out by the same surgeons and higher-risk patients were excluded
*2Infection rate reduced by 29% at 2 years after implementation of the program. SSI, surgical site infection; SOP, standard operating procedure