Surgical Site Infection
Surgical Site Infection
Surgical Site Infection
INFECTION
WHAT IS SURGICAL SITE
INFECTION?
• A surgical site infection is an infection that occurs in the wound
created by an invasive surgical procedure.
• It leads to
increased morbidity
increased mortality
Increased duration of hospital stay (7 days on an average)
increased cost
Types of
SSI
• Superficial incisional SSI
• Local factor
• Microbial factor
Patient
factor
• Older age
• Immunosuppression
• Obesity
• Diabetes mellitus
• Chronic inflammatory process
• Malnutrition
• Peripheral vascular disease
• Smoking
• Anaemia
• Radiation
• Steroid use
Local
factor
• Poor skin preparation
• Contamination of instruments
• Inadequate antibiotic prophylaxis
• Prolonged procedure
• Site and complexity of procedure
• Local tissue necrosis
• Hypoxia
• Hypothermia
Microbial
factor
• Wound Class
• Resistance
Wound
Class
Common pathogen in surgical
patients
Wound
assessment
• Abdominal operation
• Operation greater than Risk of Infection
2 hours 0 1%
• Class III or IV surgical 1 3.6%
wounds 2 9%
• Three or more 3 17%
diagnosis at time of
discharge 4 27%
Management of surgical site
infection
• Most SSIs respond to the removal of sutures with drainage of pus if present
and, occasionally, there is a need for debridement and open wound care.
• Intra-op factors
• Post-op factors
Pre-op
factors
• Preoperative antiseptic showering
• Antimicrobial prophylaxis
Antibiotic
prophylaxis
• Give antibiotic prophylaxis to patients before:
•clean surgery involving the placement of a prosthesis or
implant
• clean-contaminated surgery
• contaminated surgery.
Do not use antibiotic prophylaxis routinely for clean non-prosthetic
uncomplicated surgery.
@ left open to be closed later: the incision is packed with a sterile dressing.
@ left open to heal by second intention: packed with sterile moist gauze and
covered with a sterile dressing.
• Changing dressings
Use an aseptic non-touch technique for changing or removing
surgical wound dressings.
• Postoperative cleansing
• Use sterile saline for wound cleansing up to 48 hours after
surgery.
• Advise patients that they may shower safely 48 hours after
surgery.
• Use tap water for wound cleansing after 48 hours if the surgical
wound has separated or has been surgically opened to drain pus.
• Topical antimicrobial agents for wound healing by primary
Severe inflammatory response syndrome
and sepsis
SIRS
Two of:
hyperthermia (> 38°C) or hypothermia (< 36°C)
tachycardia (> 90 /min, no β-blockers) or tachypnea (> 20 /min)
white cell count > 12 × 109 / l or < 4 × 109 l