Surgical site infection Flashcards
Q: What is a Surgical Site Infection (SSI)?
A: SSI is a common postoperative complication caused primarily by gram-positive bacteria on the skin, and sometimes by other pathogens like anaerobic gut bacteria during bowel surgery. It is classified into three types based on the depth of infection: superficial incisional, deep incisional, and organ space SSI.
Q: What are the three types of SSI based on the depth of infection?
A: 1. Superficial incisional SSI: Limited to the skin and subcutaneous tissue.
Deep incisional SSI: Affects deeper tissues like muscle and fascia.
Organ space SSI: Involves infection deep within the organ or body cavity where the surgery occurred.
Q: When do most SSIs develop after surgery?
A: Most SSIs develop between 4 and 30 days after surgery. However, necrotizing infections like Group A strep or Clostridia can present within 48 hours and progress rapidly.
Q: What are the four categories of surgical wound classification based on the degree of contamination?
A: 1. Clean
Clean-contaminated
Contaminated
Dirty
Q: What are some risk factors for developing SSI?
A: History of surgical implant (e.g., joint replacement, mesh hernia repair), location of the wound (e.g., mouth or urinary tract), trauma history, and breaks in sterile technique.
Q: What are common symptoms reported by individuals with SSI?
A: Pain or tenderness at the surgical site, swelling, warmth, erythema, purulent drainage, and systemic signs such as fever, tachycardia, and hypotension.
Q: What might a physical exam reveal in a patient with SSI?
A: Peri-incisional signs of infection (swelling, warmth, erythema, purulent drainage), dehiscence, induration, fluctuance, and systemic signs of infection.
Q: How is Point of Care Ultrasound (POCUS) used in the evaluation of SSI?
A: POCUS is used to detect abscesses that cannot be identified clinically.
Q: Describe the characteristics and initial treatment of superficial incisional SSI.
A: Occurs up to 30 days after surgery, limited to the skin and subcutaneous tissue, presenting with peri-incisional signs and purulent drainage. Initial treatment includes bedside wound opening, debridement, and possibly tailored antibiotics if certain conditions are met.
Q: Describe the characteristics and treatment of deep incisional SSI.
A: Occurs within 30 or 90 days of surgery, extends to muscle and fascia, presenting with dehiscence, purulent drainage, and sometimes systemic signs. Treatment involves bedside wound opening, mandatory antibiotics, and possibly surgical re-exploration.
Q: Describe the characteristics and treatment of organ space SSI.
A: Occurs within 30 or 90 days of surgery, lacks peri-incisional signs but presents with systemic signs of infection. Diagnosed via drainage fluid culture or imaging. Treatment includes image-guided drain placement, empiric antibiotics, and possibly surgical re-exploration.
Q: What is the role of drainage and debridement in the treatment of SSI?
A: Drainage and debridement are crucial for removing infected and necrotic tissue, facilitating the healing process, and reducing the risk of further infection.
Q: When should antibiotics be used in the treatment of SSI?
A: Antibiotics should be used for deep incisional SSI and organ space SSI, and for superficial incisional SSI if certain conditions are met (e.g., signs extend >5 cm from wound edge, implanted material, immunocompromised patient, or systemic signs).
Q: When is surgical re-exploration indicated in the treatment of SSI?
A: Surgical re-exploration is indicated for extensive or severe deep incisional SSI, organ space SSI, or if the infection does not improve after initial bedside wound opening and antibiotics.
Q: What systemic signs of infection may indicate an SSI has spread throughout the body?
A: Fever, tachycardia, and hypotension.
