Healthcare professional in blue scrubs engages with a patient lying in a hospital bed
Healthcare professional in blue scrubs engages with a patient lying in a hospital bed

Reducing the Risk of Surgical Site Infections Starts with a Simple Choice

For more than a century, Ethicon, part of Johnson & Johnson MedTech,

has stood side-by-side with healthcare providers around the word in addressing the most critical challenges to the health of humankind. For the past two decades, that commitment has included taking a leading role in the global effort to raise awareness about the risk of surgical site infections (SSI).

The need for action to prevent SSIs is great. Even when prevention protocols are followed, a small percentage of surgical patients may develop an SSI. In the United States, more than 300,000 cases of SSIs occur each year1. The length of hospital stays for patients with SSIs increases by up to 11 days, they are five times more likely to be readmitted to the hospital and are twice as likely to spend time in an intensive care unit1-3. A single SSI can cost up to $39,0004, which costs the healthcare system an additional $3.5 to $10 billion annually1-3.

Behind each SSI is a person, and by proactively sharing information with healthcare providers and researchers around the world, lives can be saved. One way Ethicon is helping spread the word is through an global campaign called “Zero Starts With One.”  The campaign seeks to educate healthcare providers about the power of antibacterial sutures to reduce the risk of surgical site infections — because even one infection is too many. Two patients shared their experiences as part of the campaign.

Alicia Cole, Actress and Marathoner

Alicia Cole decided to have surgery to remove fibroids so that she could start a family, a routine procedure that usually requires only a day or two post-surgical stay in the hospital. 

Alicia wasn’t just ready for the procedure, she trained for it. 

“I was an athlete, and I literally trained for my surgery the same way I did when I trained for the L.A. Marathon,” Alicia says. “I went into that hospital in the best physical shape of my life to be fully prepared for my body to bounce back right away.”

But things don’t always go as planned. Fever, chills and nausea started before she left the operating room, which the surgeon first attributed to a reaction to anesthesia. Only it didn’t get better, and a tiny black dot over the incision turned out to be flesh-eating bacteria. What was supposed to be a two-day stay turned into seven surgeries, nine transfusions and a two-month hospital stay. 

“You don't ever want anybody to feel the kind of pain you feel when your body is being eaten alive,” she says. “I never dreamed it could happen to me. But it can happen to anyone.” 

Alicia’s belief that patient experience is key to improving our healthcare system led her decision to go from being a survivor to being a patient advocate — she wanted to put a face to the numbers. “Sharing my story is my mission. I want doctors and surgeons to know that they hold not just one life in their hands, but they hold a family in their hands. They hold a community in their hands. As a healthcare provider, if you could add another layer of protection to what you’re doing for your patient, why wouldn’t you?”

James Bane, Former U.S. Marine 

“I never felt that kind of pain before,” James Bane says of his experience fighting an SSI. 

This former Marine had lived a very active life and served two combat tours, during which he survived the physical force caused by a number of improvised explosive devices. Unfortunately, one of these explosions caused a back injury that included a ruptured disc and nerve damage, and James’ medical team recommended a discectomy to restore feeling in his hip and leg. 

Around five days after the surgery, he noticed that the surgical site was becoming infected. That same night, he went into septic shock. “I ended up spending about two weeks back in the hospital. The septic shock and spinal meningitis were the scariest thing I’ve ever been through. Scarier than being shot at. It was terrifying. And there was nothing I could do but lay there and be in agony and hope the antibiotics worked.” 

Ultimately, the antibiotics did work, but the scar tissue left behind from corrective procedures was pressing on his nerves much like the damaged disc had. The pain he sought to alleviate through surgery was replaced with even greater pain caused by an SSI that could have been prevented. 

“In the military, we learned that an ounce of preparation saves a pound of pain. Without the right tools, and without the right training, you’re not going to be ready for anything,” James says. “I would challenge all medical professionals to implement the best technologies that are out there, the best training that’s out there, because your patients are counting on you.” 

The Choice Surgeons Make

According to Pierre R. Theodore, MD, Vice President of Medical Affairs for Johnson & Johnson Global Public Health and Adjunct Professor of Cardiac Surgery at Stanford University, SSIs can be life altering. Risk of additional morbidity, mortality and cosmetic issues can have devastating effects on physical, mental, emotional and financial health. 

“From a patient perspective, there really is no such thing as a minor surgical site infection,” Dr. Theodore says. “I feel that the biggest misconception around surgical site infections relates to the notion that these are uncommon events or happen to other surgeons. It’s important to remember that there is no magic bullet in the management of surgical site infections.” 

Dr. Theodore points out, however, that there are simple choices surgeons can make that can greatly reduce the risk of SSI in patients. One important choice is to use antibacterial sutures. 

This is echoed by Dr. Liza Ovington, a consulting medical director for Ethicon and a 30-year expert in wound care, who calls it “a no-brainer” to choose antibacterial sutures, specifically sutures coated in the antimicrobial agent triclosan. 

“Antibacterial sutures have been shown clinically to reduce the risk of SSIs by an average of 28 percent5,*,i  and are recognized and recommended by national and international health organizations and professional societies,” Dr. Ovington says.

The Global Push For Zero

The prevention and reduction of healthcare-associated infections is a top priority for health organization around the world, and triclosan-coated sutures are currently recommended by six independent authorities: the Centers for Disease Control and Prevention; American College of Surgeons; Surgical Infection Society; World Health Organization; Robert Koch institute; and the UK’s National Institute for Health and Care Excellence (NICE).6-10 

Medical experts worldwide are beginning to specifically recognize Ethicon PLUS Sutures — the only sutures available worldwide with antibacterial protection offered by IRGACARE® MP (triclosan)**,ii — as an important component of SSI care bundle to help address SSIs.

In June of 2021, NICE issued a Medical Technologies Guidance recommendation specifically for the use of Ethicon PLUS Sutures. PLUS Sutures are the first and only sutures with triclosan antibacterial protection recommended for use in the UK’s National Health System.11 In addition to lowering the risk of SSIs, the use of these sutures also can result in a reduction of healthcare- related costs.

Zero Starts With One

It should come as no surprise that the company that invented the first mass-produced sterile sutures and helped usher in the modern era of antiseptic surgery, Ethicon and Johnson & Johnson MedTech, remain committed to making SSIs a thing of the past. 

According to Dr. Ovington, “As healthcare professionals, the power to reduce surgical site infection risk is in all of our hands, beginning with our choices. Zero starts with one.” 

Learn more about the Zero Starts With One initiative here.

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References

*In a meta-analysis of 21 RCTs, 6462 patients, 95% CI: (14, 40%), P<0.001 
** There are no competitive triclosan coated sutures that have both FDA clearance and CE Mark as of November, 2021 

  1. All triclosan-coated sutures in these RCTs were Ethicon Plus Antibacterial Sutures (MONOCRYL® Plus, VICRYL® Plus, and PDS® Plus) 
  2. A trademark of BASF. 
  1. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. 
  2. Thompson KM, Oldenberg WA, Deschamps C, Rupp WC, Smith CD. Chasing zero: The drive to eliminate surgical site infections. Ann Surg. 2011;254:430-437. 
  3. World Health Organization. WHO Guidelines for Safe Surgery, 2009. 
  4. de Lissovoy G, Pan F, Patkar A, et al. Surgical Site Infection Incidence and Burden Assessment Using Multi- institutional Real-world Data. Presented at EU ISPOR, 2011, Madrid, Spain. 1 
  5. de Jonge SW, Atema JJ, Solomkin JS, Boermeester MA. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical site infection. Brit J Surg. 2017;ePub-DOI: 10.1002/bjs.104-45. 
  6. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2016;224(1):59-74. 
  7. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. doi:10.1001/jamasurg.2017.0904. 
  8. WHO Global Guidelines for the Prevention of Surgical Site Infection, 2016. 
  9. National Institute for Health and Care Excellence (NICE) Guideline. Surgical site infections: prevention and treatment. NICE website. Accessed October 17, 2019. 
  10. Prevention of postoperative wound infections. Recommendation of the Committee for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. Bundesgesundheitsbl. 2018; 61(4):448–473. 24.  
  11. © NICE 2021. MEDICAL TECHNOLOGY GUIDANCE: PLUS SUTURES FOR PREVENTING SURGICAL SITE INFECTION. Accessed on: 28 June 2021. All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication 

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