Targeted infection control: Easing rural hospital strain and driving systemwide efficiency

Rural hospitals are the lifeline for millions of patients in the United States, serving as the backbone of community health and essential access points for surgical care. Yet, these critical facilities are operating under chronic and intensifying strain. According to recent analysis, 46% of rural hospitals in the U.S. have a negative operating margin, and 432 are considered vulnerable to closure. Severe staffing shortages, narrow margins and limited access to technology have resulted in operational pressures on general hospitals. Marginalized communities, who cannot tap into the efficiencies of larger urban systems, have been hit hardest.

Against this backdrop, otherwise preventable complications become a force multiplier, exacerbating an already overstretched system. For instance, the impact of surgical site infections (SSIs), which are estimated to occur in 2% to 4% of surgical procedures, is amplified in resource-constrained rural settings and can add up to 10 days to a patient’s hospital stay.

Each infection can add days to a patient’s hospital stay, trigger reoperations or readmissions and require intensive follow-up. This consumes a disproportionate share of capacity in hospitals, with limited operating room time, fewer inpatient beds and leaner staffing models. For hospitals already operating at the edge of their capacity, this consumes dwindling resources and contributes directly to clinician burnout.

Health care leaders and innovators must find ways to deliver high-impact solutions that are both scalable and resource-efficient enough to support the frontline clinicians who need them most.

Bridging the gap between guideline-based SSI prevention and residual risk in rural hospitals

The Centers for Disease Control and Prevention and World Health Organization have established robust recommendations and evidence-based guidelines for SSI prevention, emphasizing standardized pre-, intra- and postoperative protocols that significantly reduce infection risk when implemented with high fidelity. Yet, even under best-practice conditions, a residual burden of SSIs persists due to procedure complexity, patient-specific risk factors and the inherent limitations of systemic prophylaxis alone — and the impacts are felt more acutely in rural settings.

Though many tools for infection prevention exist in large systems, including automated surveillance platforms, advanced analytics and dedicated infection-prevention staffing, they are often priced or designed beyond the reach of smaller and rural facilities. These hospitals are held to the same clinical and regulatory expectations but must rely on manual surveillance, generalist teams and limited IT support. The challenge is not a lack of effort; it is a lack of equitable access to tools that can handle residual risk while streamlining workflow.

As a result, even when clinicians rigorously follow guidelines, SSIs still occur and place a disproportionate operational and emotional burden on rural teams already navigating multiple competing pressures with fewer resources. Without scalable, flexible solutions, infection prevention remains a reactive, resource-intensive responsibility. While SSI prevention is primarily anchored in the surgical setting, and postoperative follow-up is ideally managed by the surgeon, real-world access constraints can mean that some patients present to primary care physicians (PCPs) in the postdischarge period. In these instances, PCPs may serve as an initial point of contact when early signs of infection emerge. Here is what primary care physicians should keep in mind: Even with strong adherence to hospital-based protocols, residual infection risk remains, making vigilance, appropriate triage and clear communication with surgical teams essential to preventing complications and readmissions.

Localized, sustained-release solutions for enhanced infection control

Preventing SSIs requires approaches beyond systemic prophylaxis that address infection risk directly at the surgical site. Solutions must be practical, easy to implement, and adaptable to hospitals of all sizes, including rural and community facilities with limited staff and infrastructure.

Localized, sustained-release antibiotic delivery systems offer a targeted solution. Platforms that release antibiotics gradually at the incision site over multiple days or weeks can maintain protective levels during the critical period of wound healing. Focusing treatment where it is most needed, they may provide a proactive method to prevent SSIs, reducing systemic exposure while lowering the likelihood of infection-related complications that can disrupt hospital operations.

Designed for straightforward use, these therapies would be applied during wound closure and would be bioabsorbable, eliminating additional procedural steps. They would integrate seamlessly into standard surgical workflows, providing extended protection without adding complexity for clinicians. Moreover, by preventing infection early and locally, these solutions would be expected to generate substantial cost savings and improve the financial viability of rural institutions. Expanding access to such technologies ensures that smaller hospitals can implement advanced infection-prevention strategies previously limited to larger health systems. By addressing infection risk early and locally at the surgical site, sustained-release antibiotic delivery can help reduce complications, support hospital capacity and ease operational pressures on clinical teams managing multiple demands.

Strengthening the broader health ecosystem

The benefits of scalable, resource-efficient infection-prevention tools extend far beyond the immediate surgical setting, strengthening the wider health care ecosystem. Reducing complications like SSIs can enhance operational resilience, directly alleviating the multiple challenges rural health systems face.

The trickle-down effect from reducing SSIs can support greater availability of hospital beds and reduce the need for intensive postoperative care, surgical reinterventions and complex follow-up visits, freeing up limited capacity to address other urgent community needs. Implementing such tools can also improve workforce sustainability by avoiding complications, reducing administrative burdens and directly combating clinician burnout.

The path forward

Supporting rural clinicians with practical and effective infection prevention techniques will enhance resilience across the general health care system, improving access and outcomes for more patients.

With the adoption of accessible, high-impact strategies supporting broader national objectives for health equity, decision makers can ensure the same high standard of care and patient outcomes will be available in underserved rural communities as in high-resource urban centers.

Equitable access to effective infection-control tools not only protects patients and providers but also strengthens the resilience of health care delivery everywhere. By advancing innovative, practical solutions, these efforts help safeguard health outcomes and ensure that high-quality care remains accessible across diverse settings worldwide.

Nurit Tweezer-Zaks, M.D., MBA, serves as the chief medical officer of PolyPid, where she leads clinical strategy and the development of the company’s therapeutic pipeline. An internist and rheumatologist trained at the U.S. National Institutes of Health (NIAMS), she has over 20 years of experience in biopharmaceutical development, clinical strategy and medical leadership. Her background includes significant expertise in translational medicine, global medical leadership and financial structuring within biotechnology companies.