Surgical Site Infection

Question 1

What are risk factors for surgical site infection?

Answer 1

Patient factors:
Extremes of age
Poor nutritional state
Diabetes mellitus
Renal failure
Smoking
Co-existing infection at other site
Immunosuppression
Long post-operative stay

Operation factors
Preoperative shaving
Length of operation
Foreign material in surgical site
Insertion of surgical drain
Inadequate instrument sterilisation
Poor closure of wound
Post-operative hypothermia
Post-operative haematoma or lymphatic leak
Site of procedure - e.g. at skin crease

Question 2

when do symptoms of surgical site infection appear?

Answer 2

3-7 days post-procedure however can develop up to 3 weeks later - infection of prothetic insertion can present later - up to several months often due to bacterial spread from another location

Question 3

What are common clinical features of surgical site infection?

Answer 3

Spreading erythema
Localised pain - different from typical post-op pain
Pus/discharge from the wound
Wound dehiscence
Unexplained persistent pyrexia

Question 4

What infection for surgical site infection?

Answer 4

Wound swab for culture, especially if purulent, avoiding wound edges where possible to reduce skin flora contamination
Blood tests for infection markers - FBC, CRP and take blood cultures if evidence of systemic involvement or sepsis

Question 5

What is management of surgical site infection?

Answer 5

Removal of sutures/clips - allows for drainage of pus and opportunity for wound to be packed
Discharge or drainage of any pus
Empirical antibiotic prescription
Monitor closely for signs of sepsis

Question 6

What are pre-operative prevention of surgical site infection?

Answer 6

Prophylactic antibiotics if indicated (clean surgery involving a prosthesis, clean-contaminated surgery or contaminated surgery)
Do not remove hair routinely - if necessary to this immediately prior to surgery with an electric clipper
Patient advice - shower prior to surgery, weight loss to avoid sweaty skin folds around incision, good nutrition to promote wound healing, good diabetic control, smoking cessation

Question 7

What advice would you give patients to reduce risk of surgical site infection

Answer 7

shower prior to surgery, weight loss to avoid sweaty skin folds around incision, good nutrition to promote wound healing, good diabetic control, smoking cessation

Question 8

What are intraoperative prevention strategies for surgical site infection?

Answer 8

Prepare skin at the surgical site immediately before the incision using an antiseptic preparation (povisdone-iodine or chlorhexidine)
Change gloves or gowns if contaminated
Wear hair nets and face masks
Use appropriate interactive dressing at the end of the operation to cover all surgical incisions

Question 9

What are post-operative prevention strategies for surgical site infection?

Answer 9

Monitor wounds closely - use to see-through dressings will limit number of dressing changes, minimising the chance for bacterial contamination
Ensure the wounds in difficult areas such as skin creases and underneath skin folds (groin) are closely observed)
Refer to a tissue viability nurse for advice on appropriate dressing for the management of surgical wounds that are healing by secondary intention.
Topical antibiotics