6.11. Skin and Soft Tissue Infection - Surgical Site Infection

Question 1

How many Classes of Surgical Wounds are there?

Answer 1

4

Question 2

What does Class 1 Surgical Wounds involve?

Answer 2

Clean Wound:

This means the Respiratory, Alimentary, Genital or Urinary System have not been entered

Question 3

What does Class 2 Surgical Wounds involve?

Answer 3

Clean-Contaminated Wound:
This means the Respiratory, Alimentary, Genital or Urinary System have been entered but there is no unusual contamination

Question 4

What does Class 3 Surgical Wounds involve?

Answer 4

Contaminated Wound:

This means there is open, fresh accidental wounds (or gross spillage) from the Gastrointestinal Tract

Question 5

What does Class 4 Surgical Wounds involve?

Answer 5

Infected Wound:

This means there is existing clinical infection (infection present before the operation)

Question 6

What are the main causes of Surgical Site Infections?

Answer 6

1. Staphylococcus Aureus (MSSA and MRSA)
2. Coagulase Negative Staphylococci
3. Enterococcus
4. Escherichia Coli
5. Pseudomonas Aeruginosa
6. Enterobacter
7. Streptococci
8. Fungi
9. Anaerobes

Question 7

What are the patient risk factors for a Surgical Site Infection?

Answer 7

1. Diabetes Mellitus
2. Smoking
3. Obesity
4. Malnutrition
5. Concurrent Steroid Use
6. Colonisation with Staphylococcus Aureus

Question 8

What are the procedural risk factors for a Surgical Site Infection?

Answer 8

1. Shaving of the site the night prior to the procedure
2. Improper pre-operative skin preparation
3. Improper antimicrobial prophylaxis
4. Break in the Sterile Technique
5. Inadequate Theatre Ventilation
6. Peri-operative Hypoxia

Question 9

How is a Surgical Site Infection diagnosed?

Answer 9

1. Sending pus/infected tissue for cultures
2. Avoid Superficial Swabs (aim for deep structures)
3. Consider unlikely pathogen as a cause if obtained from a sterile site
4. Antibiotics to target the likely organisms