Surgical Site Infection

Question 1

What is a surgical site infection (SSI)?

Answer 1

An infection that occurs in the incision created by an invasive surgical procedure.

Question 2

What is the importance of SSI?

Answer 2

Leading cause of hospital morbidity - increasing ITU admission rates, doubling mortality rates, and increasing overall length of stay

Question 3

What is the primary management of SSI?

Answer 3

Prevention

Question 4

How are SSIs prevented?

Answer 4

• Good surgical technique

- Patient optimisation

Question 5

What does the incidence of SSIs depend on?

Answer 5

Type of surgery and degree of contamination (clean, clean contaminated, contaminated, or dirty surgery)

Question 6

What are the patient risk factors for SSIs?

Answer 6

• Extremes of age
• Poor nutrition status
• Diabetes mellitus
• Renal failure
• Immunosuppression
• Current smoker

Question 7

What are the operation risk factors for SSIs?

Answer 7

• Preop shaving of site of incision
• Length of operation
• Foreign material in surgical site
• Insertion of surgical drain
• Poor closure of wound

Question 8

When do the symptoms of surgical site infection typically appear?

Answer 8

5-7 days post-procedure

However can develop up to 3 weeks after, especially if prothesis

Question 9

What are the common clinical features of surgical site infections?

Answer 9

• Spreading erythema
• Localised pain
• Pus or discharge from wound
• Wound dehiscence
• Persistent pyrexia

Question 10

How deep are surgical site infections?

Answer 10

Most are superficial, but some may be deeper and can result in extensive wound breakdown

Question 11

What investigations should be done in suspected SSI?

Answer 11

• Wound swabs taken for culture at wound site

- Blood tests

Question 12

When are wound swabs for culture particularly important in SSIs?

Answer 12

If purulent discharge is present

Question 13

What area should be avoided when taking wound swabs from SSIs?

Answer 13

Wound edges (possible skin flora contamination)

Question 14

What blood tests should be done in SSIs?

Answer 14

• FBC
• CRP
• Blood cultures if evidence of systemic involvement or sepsis

Question 15

What is involved in management of SSIs?

Answer 15

• Remove sutures or clips

- Antibiotics

Question 16

Why should sutures/clips be removed in SSIs?

Answer 16

Allows for drainage of any pus and opportunity for wound packing if required

Question 17

When can prevention of SSIs take place?

Answer 17

• Pre-op
• Intra-op
• Post-op

Question 18

What is involved in the pre-op prevention of SSIs?

Answer 18

• Prophylactic antibiotics if indicated
• Do not remove hair routinely
• Patient advice

Question 19

When should prophylactic antibiotics be given pre-op?

Answer 19

• Clean surgery involving prosthesis

- Clean-contaminated or contaminated surgery

Question 20

How should hair removal be done if it is required?

Answer 20

Immediately prior to surgery with electric razor

Question 21

What patient advise should be given pre-op to reduce risk of SSI?

Answer 21

• Shower prior to surgery
• Encourage weight loss
• Optimised nutrition
• Good diabetic control
• Smoking cessation

Question 22

What is involved in intra-op prevention of SSIs?

Answer 22

• Prepare skin at surgical site immediately before the incision using antiseptic prep
• Change gloves or gowns if contaminated
• Use appropriate interactive dressing at end of operation to cover all surgical incisions

Question 23

What is involved in the post-op prevention of SSIs?

Answer 23

• Monitor wounds closely
• Ensure wounds in difficult areas are closely observed
• Refer to tissue viability nurse if necessary

Question 24

What is the advantage of see-through dressings?

Answer 24

Limit number of dressing changes for observation thus minimising chance for bacterial contamination

Question 25

What are the ‘difficult areas’ for wounds?

Answer 25

Skin creases and underneath skin folds

Question 26

What may be required for wounds in skin creases/folds?

Answer 26

Pads to separate the wound from overlying skin

Question 27

When might referral to a tissue viability nurse be useful post-op?

Answer 27

For advice on appropriate dressings for surgical wounds that are healing by secondary intention