Surgical site infection Flashcards
What is a surgical site infection?
An infection at the site of a surgical wound, usually within 1 week of surgery
- infection may prevent healing > separation of the wound edges or abscess formation in deeper tissues
What is a superficial incisional surgical site infection?
infection in area of skin where the incision was made
What is a deep incisional surgical site infection?
infection beneath the incision area in muscles and tissues.
What is an organ or space surgical site infection?
infection in any area of the body other than skin, muscle and surrounding tissue that was involved in the surgery
What is a clean wound?
an incision where:
- no inflammation is encountered during surgery
- no contamination
- respiratory, alimentary and genitourinary tracts are not entered
What is a clean-contaminated wound?
an incision where:
- the respiratory, alimentary or genitourinary tract is entered
- but no contamination occurs
What is a contaminated wound?
an incision where:
- a major break in sterile equipment occurs
- spilling of contents from GIT into the wound
- inflammation is encountered
What is a dirty/infected wound?
known infection is present at time of surgery
- perforated viscera
- acute inflammation with pus
What are some risk factors for surgical site infections?
- Dirty/contaminated operations
- Long procedures (>2 hours)
- Diabetes (hyperglycaemia impairs immune function and wound healing)
- Obesity (excess adipose tissue can impair wound healing)
- Smoking (impairs wound healing and immune function)
- Immunosupression
What are the most common bacteria that cause surgical site infection?
- Staphylococcus
- Streptococcus
- Pseudomonas
What are the clinical features of a mild surgical site infection?
erythema and tenderness without systemic symptoms
What are the clinical features of a severe surgical site infection?
- purulent discharge
- tenderness
- hot to touch
fever - abscess formation
- systemic signs of infection
What are the investigations for a surgical site infection?
- Wound swabs (organism and sensitive antibiotics)
- Blood tests (FBC, raised CRP and ESR)
What is the management of a mild surgical site infection?
- analgesia
- regular wound dressing changes
- oral antibiotics
What is the management of a severe surgical site infection?
- wound swabs
- IV antibiotics
- abscess = reopen wound for drainage and debridement
- Allow would to heal by secondary intention
What are some differential diagnosis for a surgical site infection?
- Haemtoma
- Seroma
- wound dehiscence
- Allergic reaction to sutures or dressings
What is a haematoma and what are the clinical features?
a bad bruise
- swelling, pain, possible discoloration WITHOUT fever or pus
What is a seroma and what are the clinical features?
fluid accumulation under the skin
- swelling without erythema, fever or pus
What is wound dehiscence and what are the clinical features?
- partial/total separation of wound edges due to failure of wound healing
- wound separation with potential exposure of underlying tissue usually without fever
when should nasal decolonisation occur prior to surgery?
patients positive for staphylococcus aureus because it is a likely cause of surgical site infection
- nasal mupirocin in combination with chlorhexidine body wash
which antiseptic is commonly used to prepare the skin prior to surgery?
alcohol-based solution of chlorhexidine
- NOT IF NEXT TO A MUCOUS MEMBRANE therefore use aqueous solution of chlorehexidine instead
