34th Annual Scientific Meeting proceedings

Introduction
Antibiotic resistance is rising — and our most potent response may not be stronger drugs, but smarter systems. In surgical disciplines, where infection can unravel even the most skilful intervention, monitoring surgical site infections (SSIs) becomes not just a safety measure but a strategic imperative. Surveillance doesn’t just count infections; it tells us when, where, and why they happen — and ultimately, how to stop them.

This talk builds on our broader discussion of antimicrobial resistance by exploring SSI surveillance as a complementary weapon. Knowing our infection rates is the first step to meaningful infection prevention. But how do we define SSIs in veterinary settings? How do we capture accurate data, particularly post-discharge? And what practical surveillance models can equine and small animal hospitals adopt without collapsing under the weight of bureaucracy?

What is an SSI?
A surgical site infection refers to an infection occurring at or near the surgical incision within 30 or 90 days of surgery, depending on the presence of implants. Drawing from a recent veterinary consensus process (Verwilghen et al., 2025, in review), SSIs are subdivided into:

• Superficial incisional
• Deep incisional
• Organ/space
• Implant-associated

These categories mirror those of human medicine (CDC/NHSN) and allow harmonisation across disciplines. Standardised definitions are crucial — not just for fair benchmarking, but also for ensuring interventions target the right risks.

Why Surveillance Matters
Surveillance underpins prevention. In human medicine, robust SSI tracking programs such as NSQIP and NHSN have driven reductions in infection rates and informed feedback loops for surgical performance. In veterinary settings, active surveillance remains rare, with studies revealing underreporting, especially of post-discharge infections. Yet:

• SSIs can prolong recovery, escalate costs, and lead to euthanasia in animals.
• Passive surveillance misses 20–50% of infections.
• Without data, improvement is guesswork.
• Moreover, from a One Health perspective, reducing SSIs reduces antimicrobial usage — thus playing a direct role in curbing resistance.

Surveillance Models: What's Practical?
Surveillance can be active (proactively seeking infections) or passive (waiting for them to be reported). Active systems are more accurate but demand more resources. Hybrid models exist — for example:

• Manual audits of surgical logs, hospital records, and follow-up calls
• Electronic screening algorithms integrating pharmacy and lab data
• Feedback loops to surgical teams

Veterinary hospitals might start with targeted surveillance: monitor specific high-risk procedures, collect follow-up data up to 30 or 90 days, and benchmark rates annually.

The key components of a viable system include:

Outcomes and Real-World Benefits
Hospitals implementing structured SSI surveillance have reported:

• Up to 50% reduction in SSI rates
• Improved protocol adherence and aseptic technique
• Earlier recognition of outbreaks or high-risk trends
• Enhanced client communication and trust

More importantly, data gives you leverage: when requesting funding, justifying protocol changes, or publishing results, surveillance turns anecdotes into evidence.

Challenges and Considerations

• Resource intensity: Active surveillance is labour-heavy. Solutions include selective targeting, student involvement, or digital automation.
• Post-discharge detection: Many SSIs present after discharge — thus follow-up is essential.
• Staff buy-in: Surveillance isn’t punishment. Framing it as quality improvement fosters engagement.

Conclusions
SSI surveillance should no longer be optional. As stewards of both surgical outcomes and antimicrobial responsibility, veterinary surgeons are uniquely positioned to lead this shift.

It starts with defining what we’re looking for, continues with knowing where to look, and culminates in acting on what we find.

Whether you’re in a tertiary referral hospital or a field surgery setting, SSI monitoring is doable — and it matters.

Let’s stop flying blind.

References

1. Verwilghen D, et al. Surgical site infection definitions consensus (in review).
2. Bulagonda NR et al. J Curr Surg 2018.
3. Garcia Stickney L et al. Vet Surg 2017; 46(5):631-637.
4. Turk R et al. Vet Surg 2014; 43(6):630–636.
5. Berro-Torres et al. JAMA Surg 2017.
6. Samareh et al. J Infect Public Health 2019.
7. CDC NHSN SSI Surveillance Guidelines, 2023.