Improvements in Surgical Site Infection Control in Albania: Impact of Infrastructure, Sterilization Standards, and Clinical Practices

Introduction: Surgical site infections (SSIs) are a major cause of postoperative morbidity, prolonged hospitalization, and increased healthcare costs worldwide.In Albania, SSI rates have historically been high; however, recent infrastructural and organizational reforms in tertiary hospitals have led to measurable progress.This study evaluated the effects of infrastructure modernization, centralization of sterilization services, and the introduction of disposable materials and laparoscopic techniques on SSI incidence at the University Hospital Center "Mother Teresa" in Albania.Materials and Methods: A prospective observational study was conducted in the Department of General and Digestive Surgery from October 2023 to October 2024.Data were collected on patient demographics (age, sex), surgical characteristics (upper or lower gastrointestinal; elective or emergency), comorbidities (hypertension, diabetes mellitus, malignancy), and SSI occurrence.Microbiological analyses included pathogen identification and antimicrobial susceptibility testing (AST) in accordance with the 2024 European Committee on AST guidelines.Results: Among 1,179 patients (51.2% male; mean age, 57.8 years), 5.4% developed SSIs after abdominal surgery.Infection rates were significantly higher in lower gastrointestinal procedures (57.8%) than in upper gastrointestinal procedures (42.2%).Patients aged 50 years exhibited a greater risk of SSI (p = 0.01), as did those with comorbidities (p = 0.0007) and diabetes mellitus (p = 0.0006).Mean hospital stay was markedly longer among infected patients (4.4 vs. 2.0 days; p < 0.0001).Escherichia coli (39%) and Enterococcus faecalis (22%) were the most common isolates, demonstrating notable resistance to ciprofloxacin (34%) and trimethoprim-sulfamethoxazole (31%).Reductions in infection rates were closely linked to enhanced operating room ventilation, improved sterilization practices, and the use of single-use materials.Conclusion: Albania has achieved substantial progress in SSI prevention through targeted infrastructural and procedural reforms.Nonetheless, persistent challenges-particularly antimicrobial resistance and the lack of a national SSI surveillance system-underscore the need for a coordinated, multidisciplinary strategy.Strengthening antimicrobial stewardship, standardizing perioperative protocols, and expanding the use of minimally invasive surgery are key priorities for sustaining improvements.