Surgical site infection

Question 1

What is a surgical site infection?

Answer 1

an infection that occurs after surgery in the part of the body where the surgery took place.

Question 2

What kinds of surgical site infections can a patient have?

Answer 2

SSI= surgical site infection
1. Superficial SSI= limited to skin and subcutaneous tissue 
2. Deep SSI= affecting the fascial and muscular layers 
3. Cavity space infection= within an abdominal or joint cavity 

Question 3

What causes surgical site infections?

Answer 3

• Infections after surgery are caused by germs.
• The most common of these include the bacteria Staphylococcus, Streptococcus and Pseudomonas.
• Germs can infect a surgical wound through various forms of contact, such as from the touch of a contaminated caregiver or surgical instrument, through germs in the air, or through germs that are already on or in your body and then spread into the wound. 

Question 4

What types of wounds can occur after a surgery?

Answer 4

1. Clean wounds. These are not inflamed or contaminated and do not involve operating on an internal organ. 
2. Clean-contaminated wounds. These have no evidence of infection at the time of surgery, but do involve operating on an internal organ. 
3. Contaminated wounds. These involve operating on an internal organ with a spilling of contents from the organ into the wound. 
4. Dirty wounds. These are wounds in which a known infection is present at the time of the surgery. 

Question 5

What are some risk factors for surgical site infections?

Answer 5

• age
• poor glucose control
• obesity
• smoking
• renal failure
• immunosuppression
• preoperative shaving
• length of operation

Question 6

What are the presenting symptoms of a surgical site infection?

Answer 6

The symptoms of a surgical site infection typically appear 5 to 7 days post-procedure, however can develop up to 3 weeks after (especially if a prosthesis is inserted). 
- Common clinical features: 
- Spreading erythema 
- Localised pain 
- Pus or discharge from the wound 
- Persistent pyrexia 

Question 7

What investigations are used to diagnose/ monitor surgical site infections?

Answer 7

• Wound Swabs
• Blood Tests → markers of infection
• Blood Cultures → if any evidence of sepsis
• Cross-Sectional Imaging → assess for deeper collections or necrotising fasciitis

Question 8

How are surgical site infections managed?

Answer 8

• Remove any sutures or clips to allow pus to drain, washout of the wound and wound left open+ Empirical antibiotic therapy
• New sutures should not be placed because it creates a potential space for pus collection if there a residual infection after the washout

1. Preoperatively
   - Don’t remove body hair routinely (if you do, use electrical clippers instead of razors)
   - Antibiotic Prophylaxis → if placement of prosthesis or valve
   - Patient Advice → encourage weight loss, smoking cessation, optimise nutrition, and ensure good diabetic control
2. Intraoperatively
   - Prepare skin with alcoholic chlorhexidine
   - Cover surgical site with dressing

Question 9

What complications may arise from a surgical site infection?

Answer 9

Surgical wound infection complications can be categorized into local and systemic ones. Local complications include delayed and non-healing of the wound, cellulitis, abscess formation, osteomyelitis as well as further wound breakdown.