surgical site infection

Question 1

how should surgical wounds be managed, how would they present

Answer 1

aseptic non touch technique for change/ remove.
sterile saline for the 48 hrs after

can shower more than 48 hrs after, or if been drained/ opened use tap water.

spreading erythema, localised pain, pus/discharge from the wound, or a persistent pyrexia

Question 2

definition of surgical site infection

Answer 2

To be classified as a surgical site infection, the wound must:

occur within 30 days after the surgery (in the case of organ/space infections with an implant in situ this is one year)
only include the skin, subcutaneous tissues, deep layers or distant organs, and
have either purulent drainage or organisms isolated from the wound site.

Question 3

risk factors for wound infection, personal vs procedural.

Answer 3

advanced age, malnutrition, hypovolemia, obesity, steroid use, diabetes, use of immunosuppressive agents, smoking, and coexistent infection at a remote site.

Procedure-related risk factors include the formation of a hematoma, the use of foreign material such as drains, leaving dead space, prior infection, duration of surgical scrub, preoperative shaving, poor skin preparation, long surgery, poor surgical technique, hypothermia, contamination from the operating room, and prolonged perioperative stay in hospital

Question 4

typical timeframe for SSI, and Mx

Answer 4

usually around day 3-7 (5)

wound swab if purulent, avoiding skin edges to prevent contamination

Flucloxacillin (narrow spectrum for skin/ ulcer infections)or other broad spectrum antibiotic. may be specific to area of surgery done.

remove clips or stiches to open and allow drainage

debridement if significant.
consider removal of implant due to biofilm formation.

Question 5

most common organisms

Answer 5

endogenous causative organisms are S. aureus, coagulase-negative staphylococci, Enterococcus, and Escherichia coli.

exogenous organisms are staphylococci and streptococci