Epidemiological patterns, risk factors, and prevention gaps of surgical site infections in operating rooms: a hospital-based surveillance study

Background Surgical site infections (SSIs) remain a major cause of postoperative morbidity, prolonged hospitalization, and increased healthcare costs. Objective To evaluate the incidence, risk factors, microbiological profile, preventive measures, and outcomes of SSIs to inform targeted perioperative strategies. Methods A hospital-based surveillance cohort study included 4,632 patients undergoing 4,860 surgical procedures between January 2022 and December 2024. Multivariate logistic regression identified independent predictors. Results A total of 382 patients developed SSIs (8.25%), corresponding to an incidence density of 12.4 per 1,000 patient-days. Independent predictors included hypoalbuminemia (OR 2.91), contaminated wounds (OR 2.83), emergency surgery (OR 2.66), operative duration >120 min (OR 2.41), and >20 operating room door openings (OR 1.77). Additional risk was associated with diabetes, anemia, ASA ≥ III status, and perioperative transfusion. Adherence to timely antibiotic prophylaxis and chlorhexidine skin preparation significantly reduced the risk of SSI (OR 0.39–0.51). Staphylococcus aureus accounted for 31.4% of cases, while Gram-negative bacilli exhibited high multidrug resistance. SSIs prolonged hospital stay by 8.9 days, tripled ICU admissions, increased 30-day mortality fourfold, and added approximately USD 2,450 in direct costs. The predictive model demonstrated strong discrimination (AUC 0.84) and good calibration. Conclusion SSIs impose substantial clinical and economic burdens. Optimized perioperative care, strict adherence to prophylactic protocols, and improved environmental control measures are critical to reducing infection rates and improving surgical outcomes.