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Surgical Site Infections (SSIs) are potential complications associated with any type of surgical procedure. Although SSIs are among the most preventable Health-Associated Infections (HAIs), they still represent a significant burden in terms of patient morbidity and mortality and additional costs to health systems and service payers worldwide. For these reasons, the prevention of SSI has been receiving considerable attention by the Health community and is of paramount importance for surgical patient outcomes.
SSIs are multifactorial entities, with many risk factors described. Factors related to the patient itself: age, gender, lifestyle, body mass index, pre-existing infection, diabetes, comorbidities, and surgical history; and factors related to the surgical procedure: type of surgery, pre-surgical preparation (hair removal, skin preparation, and hand/forearm antisepsis), management of infected or colonized surgical equipment, antimicrobial prophylaxis, and colonization of suture material.
Patient factors are non-modifiable, with exception of comorbidities, that can be optimized during the pre-operative period.
Procedure-related factors may also be non-modifiable, mainly the type of procedure and its contamination classification, but the majority can be included in the preventive measures of SSI.
To reduce the risk of suture contamination and therefore of SSI, suture materials can be coated with antibacterial agents such as triclosan (polychloro phenoxy phenol), a broad spectrum antimicrobial that affects gram-positive and gram-negative bacteria. Triclosan has been widely used for more than 40 years in consumer and health-care products, including toothpaste, soap, hand hygiene products, and surgical scrubs and it appears to be safe and effective against bacteria. In 2002, FDA approved its use as coating material for surgical sutures. Since then, 3 sutures have appeared in the market: Vycril Plus, Monocryl Plus and PDS Plus, all commercialized by the same brand.
These sutures have been tested in many studies and compared with non-coated equivalents in various RCTs, showing evidence of reduction of SSI risk without compromising wound healing.
Further studies and evidence are needed to turn this conditional recommendation with moderate quality evidence into a recommended measure to prevent SSIs.