Surgical Infections

Question 1

Define the timeline of surgical site infections (SSI)?

Answer 1

• Occuring within 30 days if NO implants
• Occuring within 90 days if implants

Question 2

Who is at high risk for surgical site infections?

Answer 2

• Tobacco use
• DM
• Malnutrition
• Obesity
• Older age
• Anemia
• Staph carriers
• CKD

Question 3

Are surgeries due to trauma or emergent causes at higher risk for SSI?

Answer 3

Yes

Question 4

What are the three categories of SSI?

Answer 4

• Superficial incisional
• Deep incisional
• Organ space

Question 5

What SSI may present with pain out of proportion?

How soon after surgery can it present?

Answer 5

Necrotizing Infection

As soon as 24 hours post op, often with sepsis

Question 6

What is the most common pathogen causing SSIs?

What body system is E. Coli the most common?

Answer 6

Staphylococcus aureus

GI Tract and Urological

Question 7

What are some signs and symptoms of SSI?

Answer 7

• Pain at surgical site
• Erythema beyond normal post-op
• Edema beyond normal post-op
• Cellulitis
• +/- purulent discharge, abscess, wound dehiscence, fever

Question 8

What diagnostic imaging should be ordered in an suspected deep and organ space SSI?

What is the treatment for deep or organ space SSI?

Answer 8

CT or MRI

I&D and washout in OR, removal of any implanted material

Question 9

What are some preoperative interventions to prevent SSI?

Answer 9

• Patient cleansing with Hibaclens night before surgery
• Antibiotic prophylaxis
• Shaving of operative site with electric clippers, not a razor
• Pre-operative skin prep with alcohol pased prep
• Treatment of known colonization with MRSA (nasal mupirocin)

Question 10

In order to prevent SSI, tight intraoperative glycemic control is required. What is the goal of blood glucose?

Answer 10

< 200mg/dL

Question 11

All antibiotic prophylaxis of SSI should include coverage for Staph aureus, when should vancomycin be added to regimen?

Answer 11

Documented staph colonization (carrier)

Question 12

When should antibiotic prophylaxis be infused prior to surgery?

Is dosing weight-based?

Answer 12

Within 60 minutes of the procedure

Yes

Question 13

What antibiotic is most commonly used for antibiotic prophylaxis?

What body system procedures should have metronidazole added?

Answer 13

Cefazolin

GI Tract, HEENT, Urologic