Surgical Site Infections (SSIs)

Surgical site infections (SSIs) remain one of the most costly and preventable complications in modern healthcare, occurring in 2–5% of surgical patients (Berríos-Torres et al., 2017). These infections lead to prolonged hospital stays, increased morbidity, and higher healthcare costs. Studies indicate that environmental contamination is a significant factor in SSI occurrence, with up to 30% of SSIs attributable to poor OR hygiene (Anderson et al., 2017). At Kismet Technologies, we recognize that comprehensive infection control strategies must include advanced disinfection methods beyond traditional chemical cleaning. Our commitment to innovation in antimicrobial technology positions us at the leading edge of surgical environment hygiene, reducing the risk of SSIs by providing next-generation solutions that enhance cleaning efficacy and persistence. The discussion highlights the latest advancements in operating room (OR) cleaning, covering the four levels of disinfection, the scientific evidence behind their effectiveness, and emerging technologies such as persistent antimicrobial surface coatings.Shorten with AI

Levels of Cleaning and Disinfection in Surgical Settings

A robust OR disinfection strategy relies on four distinct levels: cleaning, low-level disinfection (LLD), intermediate-level disinfection (ILD), and high-level disinfection (HLD). Each level plays a crucial role in reducing microbial load and preventing contamination that could lead to SSIs.

• Cleaning (Physical Removal): The first and most fundamental step, removing visible debris, organic material, and biofilms to enable effective subsequent disinfection. Proper cleaning can reduce surface microbial contamination by 80–90% (Carling et al., 2006).
• Low-Level Disinfection (LLD): Eliminates most vegetative bacteria, some viruses, and fungi, suitable for high-touch surfaces in ORs such as floors, handles, and furniture. However, studies indicate that standard disinfectants often leave behind residual contamination, with pathogens persisting on 30–50% of surfaces even after routine cleaning (Rutala et al., 2008).
• Intermediate-Level Disinfection (ILD): Targets mycobacteria and a broader spectrum of pathogens, often used for OR equipment surfaces where a higher level of decontamination is necessary. ILD has been shown to significantly reduce microbial bioburden and is particularly effective in environments where bloodborne pathogens may be present (Rutala & Weber, 2016).
• High-Level Disinfection (HLD): Approaching sterilization, this level eradicates all microorganisms except bacterial spores and is critical for reusable medical instruments such as endoscopes. Adherence to HLD protocols can virtually eliminate instrument-borne SSIs, as seen in reductions of Pseudomonas and Mycobacterium transmission (Muscarella, 2014).

Effectiveness of Each Disinfection Level in Preventing SSIs

Each level of disinfection plays a critical role in reducing the risk of SSIs, though their effectiveness varies.

Thorough cleaning alone can reduce microbial loads by more than 80% on surfaces, significantly lowering the baseline risk of contamination. This reduces the baseline risk – e.g. fewer bacteria on OR tables and lights mean fewer opportunities for contamination of sterile instruments or gloves. However, residual pathogens often remain after cleaning alone. Pathogens like S. aureus can survive on dry surfaces for up to 7 months and are not eliminated without proper disinfection. Thus, cleaning must be followed by disinfection.

Low- and Intermediate-level disinfection of OR environmental surfaces have been correlated with lower rates of environmental contamination by organisms that cause SSIs (Anderson et al., 2017). For example, improved daily cleaning of high-touch surfaces in ORs and adjacent areas has been associated with reductions in postoperative infection rates in some studies. One analysis found that when hospitals raised cleaning compliance (measured by fluorescent markers on surfaces) from 40% to 80%, they saw significant decreases in environmental contamination and a trend toward fewer SSIs (Carling et al., 2010). Proper disinfection of floors and surfaces also matters because airborne bacteria in the OR can originate from floor disturbance – OR traffic and door openings stir up particles that land on surgical fields. Minimizing microbial presence on floors and surfaces through proper cleaning and disinfection helps mitigate this risk.Shorten with AI

High-level disinfection directly prevents infections by ensuring devices like endoscopes don’t introduce pathogens into surgical sites. There are documented cases of SSIs traced to improperly disinfected instruments, underscoring that HLD (or sterilization) of any item entering the patient is crucial (Berríos-Torres et al., 2017). While it is challenging to quantify the exact impact of each disinfection level on SSI rates—given that multiple precautions function together—evidence strongly supports that rigorous cleaning and appropriate disinfection of the OR environment substantially reduce SSI risks by limiting microbial contamination from both surfaces and instruments. Conversely, lapses in these practices (e.g. a surface not cleaned, or an endoscope not fully disinfected) have led to outbreaks and higher SSI incidence.

Innovations in OR Cleaning Protocols and Disinfectant Technologies

Traditional manual cleaning and chemical disinfection, while essential, have limitations such as short-lived efficacy and reliance on manual application. Studies have found that cleaning compliance in hospitals is often inconsistent, with fewer than 50% of OR surfaces properly disinfected (Carling et al., 2010). To address these challenges, hospitals are increasingly turning to no-touch disinfection technologies like UV-C light and hydrogen peroxide vapor (HPV). These innovations provide an additional layer of protection but still require manual cleaning as a precursor.

• UV-C Disinfection: Has been shown to reduce multidrug-resistant organisms by up to 80% when used as an adjunct to standard cleaning protocols (Anderson et al., 2017).
• Hydrogen Peroxide Vapor (HPV): Proven to lower healthcare-associated infection rates by 64% when implemented as part of a comprehensive infection control strategy (Passaretti et al., 2013).

Rigorous cleaning and disinfecting are not always possible between patients.  Antimicrobial surfaces or coatings can provide an additional layer of protection.  Kismet has developed a line of products called Kismet Clean.  These products provide long-lasting surface protection.

What Makes Kismet Clean Different?

Our proprietary technology integrates cerium oxide with chitosan, offering a dual-action antimicrobial mechanism that distinguishes Kismet Clean from other surface coatings:

• Cerium Oxide Nanoparticles: These particles exhibit powerful antimicrobial properties by generating reactive oxygen species (ROS) in the presence of pathogens and upon exposure to moisture. This reaction disrupts bacterial cell membranes and inhibits pathogen growth without causing harm to human tissues.
• Chitosan Enhancement: A natural biopolymer derived from chitin; chitosan enhances the adhesion of cerium oxide to surfaces while also possessing intrinsic antimicrobial properties. This combination ensures that the coating remains effective even after repeated exposure to contaminants.
• Durability & Persistence: Unlike UV-C or hydrogen peroxide vapor that require active application cycles, Kismet Clean provides continuous protection without the need for reapplication for weeks or even months, significantly reducing bioburden on the surface.
• Environmentally Friendly & Non-Toxic: Unlike some chemical disinfectants that may produce harmful by-products, Kismet Clean is safe for prolonged use combining a natural biopolyment with a mineral.

Conclusion

Preventing SSIs requires a multi-faceted approach that includes rigorous manual cleaning, strategic use of chemical disinfectants, innovative technologies including products like Kismet Clean that provide long-lasting surface protection. By integrating these strategies, healthcare facilities can significantly reduce pathogen transmission in surgical environments.

At Kismet Technologies, we are committed to providing innovative solutions that provide superior protection for patients and healthcare workers alike. To learn how Kismet Clean can enhance your hospital’s cleaning protocols, contact us today to explore customized solutions for your facility.

References

• Anderson, D. J., et al. (2017). Strategies to prevent surgical site infections in acute care hospitals: 2017 update. Infection Control & Hospital Epidemiology, 38(5), 579-599.
• Berríos-Torres, S. I., et al. (2017). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surgery, 152(8), 784-791.
• Carling, P. C., et al. (2006). Improving cleaning of the environment in hospitals: A decade of progress. Infection Control & Hospital Epidemiology, 31(9), 997-1004.
• Kalosh, A. (2024). Kismet Clean cruise study shows ‘remarkable’ microbial reduction, lasting protection. Seatrade Cruise News.
• Muscarella, L. F. (2014). Prevention of disease transmission during flexible endoscopy. Current Opinion in Infectious Diseases, 27(4), 404-410.
• Passaretti, C. L., et al. (2013). An evaluation of environmental decontamination with hydrogen peroxide vapor for reducing the risk of patient acquisition of multidrug-resistant organisms. Clinical Infectious Diseases, 56(1), 27-35.
• Rutala, W. A., & Weber, D. J. (2016). Disinfection, sterilization, and antisepsis: An overview. American Journal of Infection Control, 44(5), e1-e6.