My opinion

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Since the onset of pandemic, it has been anecdotally observed that incidence of surgical site infections (SSIs) may be coming down [1-6]. One of the explanations thought to be underlying this presumed reduction in SSIs is sterner as well as more complete use of personal protective equipment (PPE) not only by providers and staff in the perioperative areas as well as postoperative areas but also by patients and their families too [7-14]. Now the question arises whether incidence of SSIs will crop up again once the pandemic mitigating practices are loosened not only outside operating rooms but also inside them. There may be research investigators looking for answers and waiting for evidence. However, it may appear common sense to expect providers and staff continue pandemic mitigating practices as SSIs mitigating practices in the post-pandemic era as sternly and as completely as during pandemic. If that becomes difficult to incorporate and regulate, the microbiological evidence can be created by matching the bacterial genome (predominantly Staphylococcus aureus [15-20]) causing SSIs in patients to the bacterial genome harbored (predominantly in noses) within providers and staff in the operating rooms. If that turns out to be inconclusive [21-25], the evidence can search to match Staphylococcus aureus genome causing SSIs in patients to Staphylococcus aureus genome in their own noses and their families' noses. If that turns out to be true, it may make the case for patients and their families to continue pandemic mitigating practices as SSIs mitigating practices in the post-pandemic era as sternly and as completely as during pandemic. If that remains difficult, there may be few options at least in the operating rooms besides the administration of increasing number of gut microbiome-suppressing [26] perioperative antibiotics to patients after futuristically protocolizing and policing for perioperatively decolonizing and decontaminating not only patients' noses and their nasal microbiomes [27-30] but also their personal caregivers' noses and their nasal microbiomes as well as professional caregivers' noses and their nasal microbiomes including healthcare providers' noses and their nasal microbiomes as well as healthcare staff's noses and their nasal microbiomes. In the interim, the surgical site preps [31-32] can be delayed until after the patients' airways have been intubated and secured so that their aerosols do not get deposited on to their surgical sites after preps have been done. If the patients are undergoing procedures under sedation, the patients can be made to have oxygen mask covering their faces to reduce their droplets directly depositing onto the surgical sites after they have been prepped. However, unless the surgical sites and airways are common and one and the same, the best option in all the cases may be placing a clear anesthesia screen drape [33] as SSI (suppressing self-infection [34]) screen drape before the surgical site is prepped so that even awake patients during Cesarean sections [35-47] can be free to talk, laugh, cough, burp and vomit without soiling the being prepped surgical sites with their droplets from their mouths and noses. It may not be too much to ask and too much to do considering that providers and staff are always expected to re-prep the surgical sites when they inadvertently touch and thus contaminate the prepped surgical sites. Moreover, it can be envisioned for future clinical microbiological research investigators to decipher that not only bacterial genomes but also viral genomes may be discovered not only from prepped surgical sites but also from SSI screen drapes to outline whether SSIs are the reflection of patients as reservoirs [48] or their personal or professional caregivers as reservoirs with portal of exit being their mouths and noses and modes of transmission being breathing, talking, laughing, coughing, burping, vomiting without protecting prepped surgical sites as portal of entry by covering their noses and mouths with stern and complete PPE and clear SSI screen drapes as additional barriers in-between.

Reference(s)

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1.    Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC7488636/

2.    Effect of pandemic OR supply shortage on SSIs https://www.o rmanager.com/briefs/effect-of-pandemic-or-supply-shortage-on-ssis/

3.    Reduction in nosocomial infections during the COVID-19 era: a lesson to be learned https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC7676752/

4.    COVID-19 Impact on HAIs https://www.cdc.gov/hai/data/portal /covid-impact-hai.html

5.    2020 National and State Healthcare-Associated Infections (HAI) Progress Report https://arpsp.cdc.gov/profile/n ational-progress/united-states

6.    Impact of COVID-19 Protocols on Primary and Revision Total Hip Arthroplasty https://www.sciencedirect .com/science/article/pii/S088354032200585X

7.    [Investigations into the use of respiratory masks for reducing the MRSA-exposure of veterinarians visiting regularly pig herds--first experiences] https://pubmed.ncbi.nlm.nih.gov/21465769/

8.    Gloves, gowns and masks for reducing the transmission of meticillin?resistant Staphylococcus aureus (MRSA) in the hospital setting https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC7026606/

9.    Use of gloves, a gown or a mask for contact with hospitalised patients with Staphylococcus aureus resistant to a common antibiotic (MRSA) https://www.cochrane.org/CD007087/WOUNDS_use-gloves-gown-or -mask-contact-hospitalised-patients-staphylococcus-aureus-resistant-common

10.   Airborne Staphylococcus aureus in different environments—a review https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC6900272/

11.   Impact of dust on airborne Staphylococcus aureus’ viability, culturability, inflammogenicity, and biofilm forming capacity https://www.sciencedirect .com/science/article/pii/S143846392030554X

12.   Significance of Airborne Transmission of Methicillin-Resistant Staphylococcus aureus in an Otolaryngology–Head and Neck Surgery Unit https://jamanetwork.co m/journals/jamaotolaryngology/fullarticle/482358

13.   Airborne MRSA and Total Staphylococcus aureus as Associated With Particles of Different Sizes on Pig Farms https://academic.oup.com/annweh/arti cle/62/8/966/5061513

14.   Airborne Spread of Methicillin Resistant Staphylococcus aureus From a Swine Farm https://www.frontiersin.o rg/articles/10.3389/fvets.2021.644729/full

15.   Evolutionary genomics of Staphylococcus aureus: Insights into the origin of methicillin-resistant strains and the toxic shock syndrome epidemic https://www.pnas.org/doi/10.1073/pnas.1610980 98

16.   Comparative genome-scale modelling of Staphylococcus aureus strains identifies strain-specific metabolic capabilities linked to pathogenicity https://www.pnas.org/doi/10.1073/pnas.152319 9113

17.   Species-Specific and Ubiquitous-DNA-Based Assays for Rapid Identification of Staphylococcus aureus https://www.ncbi.nlm.nih.gov/pmc/article s/PMC104596/

18.   Bacterial DNA load in Staphylococcus aureus bacteremia is significantly higher in intravascular infections https://journals.pl os.org/plosone/article?id=10.1371/journal.pone.0266869

19.   Whole Genome Sequencing Provides an Added Value to the Investigation of Staphylococcal Food Poisoning Outbreaks https://www.frontiersin.o rg/articles/10.3389/fmicb.2021.750278/full

20.   Staphylococcus aureus secretes immunomodulatory RNA and DNA via membrane vesicles https://www.nature.com/articles/s41598-020 -75108-3

21.   Microbial Forensics: Beyond a Fascination https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC7121623/

22.   Microbial Forensics https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC7149751/

23.   Forensic Applications of Microbiomics: A Review https://www.frontiersin.o rg/articles/10.3389/fmicb.2020.608101/full

24.   The Forensic Microbiome: The Invisible Traces We Leave Behind http s://nij.ojp.gov/topics/articles/forensic-microbiome-invisible-traces-we-leave-behind

25.   Can microbes keep time for forensic investigators? https://www.pnas.org/doi/10.1073/pnas.171815 6114

26.   Antibiotics wreak havoc on athletic performance: Knocking out gut bacteria deflates the will, ability to exercise https:/ /news.ucr.edu/articles/2022/06/01/antibiotics-wreak-havoc-athletic-performance

27.   Nasal decontamination for the prevention of surgical site infection in Staphylococcus aureus carriers https://www.ncbi.nlm.nih.gov/pmc/articl es/PMC6481881/

28.   Nasal microbiome disruption and recovery after mupirocin treatment in Staphylococcus aureus carriers and noncarriers https://www.researchsquare.com/article/r s-1633597/v1

29.   Effect of mupirocin for Staphylococcus aureus decolonization on the microbiome of the nose and throat in community and nursing home dwelling adults https://journals.pl os.org/plosone/article?id=10.1371/journal.pone.0252004

30.   Compositions and Methods for Augmenting the Nasal Microbiome https://nau.edu/nau-research/available-technologies/biomedical-innovations/augmenting -the-nasal-microbiome/

31.   Make No Mistake: Prepping the Skin Takes Time https://www.aorn.org/outpatient-surgery/articles/specia l-editions/2017/may-infection-control/make-no-mistake-prepping-the-skin-takes-time

32.   5 Ways to Standardize Skin Prepping Practices https://www.aorn.org/outpatient-surgery/articles/speci al-editions/2018/may-infection-control/5-ways-to-standardize-skin-prepping-practices

33.   Call for Standalone Clear Anesthesia Screen Drape www.webmedcentral.com/article_view/5599

34.   Self-infection with speech aerosol may contribute to COVID-19 severity https://onlinelibrary.wiley.com/doi/10 .1111/joim.13370

35.   Surgical Site Infections https ://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections

36.   Surgical site infections: epidemiology, microbiology and prevention https://pubmed.ncbi.nlm.nih.gov/19022115/

37.   Microbiology of surgical site infections complicating breast surgery https://pubmed.ncbi.nlm.nih.gov/20695828/

38.   The time course and microbiology of surgical site infections after head and neck free flap surgery https://pubmed.ncbi.nlm.nih.gov/25425457/

39.   Methicillin-Resistant Staphylococcus Aureus https://www.ccohs.ca/oshanswers /biol_hazards/methicillin.html

40.   Methicillin-resistant Staphylococcus aureus (MRSA) https://www.cdc.gov/mrsa/community/index.html

41.   Staph infections in the hospital https://medlineplus.gov/ency/pati entinstructions/000449.htm

42.   Staphylococcus aureus in Healthcare Settings https://www.cdc.gov/hai/organisms/staph.html

43.   Table 2 Distribution of pathogens of surgical site infection after cesarean section (n = 62) From: The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis https://bmcsur g.biomedcentral.com/articles/10.1186/s12893-021-01154-x/tables/2

44.   The risk factors and care measures of surgical site infection after cesarean section in China: a retrospective analysis https://bmcsurg.biomedc entral.com/articles/10.1186/s12893-021-01154-x

45.   Surgical site infections after cesarean sections at the University Clinical Center of Kosovo: rates, microbiological profile and risk factors https://bmcinfectdi s.biomedcentral.com/articles/10.1186/s12879-019-4383-7

46.   Surgical Site Infection in Cesarean Section Operation: Risk and Management https://openaccesspub.org/ijip/article/1090

47.   Surgical site infections following caesarean sections in the largest teaching hospital in Ghana https://www.sciencedirect .com/science/article/pii/S259008892200004X

48.   Lesson 1: Introduction to Epidemiology Section 10: Chain of Infection https://www.cdc.gov/csels/dsepd /ss1978/lesson1/section10.html

Source(s) of Funding

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NOT APPLICABLE

Competing Interests

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NOT APPLICABLE