Patients’ experiences of acquiring a deep surgical site infection: An interview study Annette Erichsen Andersson, RN, MSc, a,b Ingrid Bergh, RN, PhD, a,c Jon Karlsson, MD, PhD, d,e and Kerstin Nilsson, RN, PhD a,c Go ¨teborg and Sko ¨vde, Sweden Background: The negative impact of surgical site infection (SSI) in terms of morbidity, mortality, additional costs, and length of stay (LOS) in the hospital is well described in the literature, as are risk factors and preventive measures. Given the lack of knowledge regarding patients’ experiences of SSI, the aim of the present study was to describe patients’ experiences of acquiring a deep SSI. Methods: Content analysis was used to analyze data obtained from 14 open interviews with participants diagnosed with a deep SSI. Results: Patients acquiring a deep SSI suffer significantly from pain, isolation, and insecurity. The SSI changes physical, emotional, social, and economic aspects of life in extremely negative ways, and these changes are often persistent. Conclusion: Health care professionals should focus on strategies to enable early diagnosis and treatment of SSIs. The unacceptable suffering related to the infection, medical treatment, and an insufficient patient-professional relationship should be addressed when planning individual care, because every effort is needed to support this group of patients and minimize their distress. All possible measures should be taken to avoid bacterial contamination of the surgical wound during and after surgery to prevent the development of SSI. Key Words: Surgical site infection; patient experience; qualitative study. Copyright ª 2010 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. (Am J Infect Control 2010;38:711-7.) Surgical site infection (SSI) is a potentially prevent- able complication that accounts for about 20% of all hospital-acquired infections (HAIs). The overall HAI rate is reported to be approximately 11%. 1 An esti- mated 2%-3% of all patients undergoing surgery will acquire an SSI. In a US study comprising 163,624 pa- tients, an SSI rate of 4.3% was reported. 2 An English study comprising 67,410 surgical procedures reported a similar rate (4.2%). 3 When assessing SSI rates, it is important to remember that 50% or more of SSIs occur after discharge and thus are not available for most hos- pital infection control surveillance programs. 4,5 The incidence of SSI varies among different types of sur- gery, with higher rates after bowel surgery (10%) and lower rates after abdominal hysterectomy (2.5%) and primary total hip replacement (3.1%) and knee re- placement (1.9%). 3,6 The origin of SSI involves complicated interactions between the host/patient in terms of underlying risk factors, such as smoking, diabetes, malnutrition, and preoperative infection; the surgical technique 2,7 ; and environment factors in the operating room, including the application of measures to decrease intraoperative wound contamination. 8,9 SSIs are associated with in- creases in postoperative length of stay (LOS) in the hos- pital, costs, hospital readmission rate, and use of antimicrobial agents. 1 Recent data from the US Nation- wide Inpatient Sample showed that the presence of any SSI extended the LOS by 9.7 days and was associated with increased costs of $20,842 per admission; nation- wide, nearly 1 million extra inpatient days and $1.6 bil- lion in excess costs were documented. 6 Only a few studies have investigated quality of life (QoL) in relation to SSI occurring after surgery. 10-12 Even though the data are limited, the available data in- dicate a significant reduction in health-related QoL in affected patients. The lack of knowledge of patients’ experiences in relation to deep SSI justifies the present interview study, given that more detailed knowledge in this field might lead to better understanding of this From the Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Go ¨ teborg, Sweden a ; Department of Anesthesia, Surgery, and Intensive Care, Sahlgrenska University Hospi- tal, Go ¨teborg, Sweden b ; School of Life Sciences University of Sko ¨ vde, Sko ¨vde, Sweden c ; Department of Orthopedics, Sahlgrenska University Hospital, Go ¨ teborg, Sweden d ; and Institute of Clinical Sciences, Sahl- grenska Academy, University of Gothenburg, Go ¨teborg, Sweden. e Address correspondence to Annette Erichsen Andersson, RN, MSc, Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Box 457, SE 405 30 Gothenburg, Sweden. E-mail: annette.erichsen@vgregion.se. 0196-6553/$36.00 Copyright ª 2010 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.ajic.2010.03.017 711