A Comprehensive Curriculum for Surgical Infectious Diseases

Author(s):
Lillian Kao; Donald Fry; Daithi Heffernan; Laura Brown; Miguel Cainzos; Jeffrey Chipman; Catherine Hunter; Mayur Narayan; Sebastian Schubl; Philip Barie

Background:

Infection is the leading postoperative complication; surgical site infection in particular is a major cause of healthcare-acquired infection. Prevention and management of infection is a cornerstone of surgical practice for all specialties, but especially so for acute care surgeons, who manage infections in general surgery and subspecialty patients, often when critically ill. However, surgeons have been criticized for non-adherence to evidence-based best practices. A needs assessment by SIS identified that formal instruction in surgical infectious diseases is required for trainees and practicing surgeons.

Hypothesis:

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Methods:

A series of interactive inclusive video roundtables held in 2021 for a needs assessment identified topics for inclusion. An list of 95 suggestions was refined and supplemented by broad solicitation of expert opinion. A total of 166 topics were identified before sorting into 8 domains and 62 categories.

Results:

Domains include The History of Surgical Infections; Microbiology; Infection and the Host; Risk factors for Surgical Infection; The Operating Room Environment; Antimicrobial Prophylaxis and Therapy; Specific Surgical Infections-Infections by Surgical Specialty; Surgical Infections in the Intensive Care Unit; The Hospital Infection Apparatus. As three examples, within Microbiology: The Human Microbiome in Health and Disease; The Microbiology Laboratory; Microbial Virulence and Antimicrobial Resistance; Gram-Positive, -Negative, and Anaerobic Pathogens; Yeasts and Fungal Pathogens; Viral Pathogens of Surgical Importance; Atypical Pathogens; and Prions. Under Infection and the Host: Host Defenses; Sepsis and Septic Shock; Multiple Organ Dysfunction Syndrome; Immunosuppression; Active and Passive Immunity; and Principles of Source Control. Within The Operating Room Environment: Patient and Provider Safety; Decolonization, Asepsis, and Antisepsis; Operating in Austere Environments; and The Surgeon: Immunomodulator or Fomite?

Conclusions:

Surgeons are responsible for the total care of their patients; a comprehensive tool kit is required to do so, especially regarding unusual, complex infections or compromised hosts. Infection prevention and management should not be delegated to other specialties; rather, surgeons need expertise for acceptance into multidisciplinary teams. Shortages of practitioners are foreseeable. Consideration should be given to fostering and promulgating expertise, especially among younger surgeons, through training grants or creation of fellowship programs.