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Peri-Operative Care [16] > Surgical Site Infection > Flashcards

Surgical Site Infection Flashcards

1
Q

What is a surgical site infection (SSI)?

A

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

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2
Q

What is the importance of SSI?

A

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

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3
Q

What is the primary management of SSI?

A

Prevention

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4
Q

How are SSIs prevented?

A
  • Good surgical technique

- Patient optimisation

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5
Q

What does the incidence of SSIs depend on?

A

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

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6
Q

What are the patient risk factors for SSIs?

A
  • Extremes of age
  • Poor nutrition status
  • Diabetes mellitus
  • Renal failure
  • Immunosuppression
  • Current smoker
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7
Q

What are the operation risk factors for SSIs?

A
  • Preop shaving of site of incision
  • Length of operation
  • Foreign material in surgical site
  • Insertion of surgical drain
  • Poor closure of wound
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8
Q

When do the symptoms of surgical site infection typically appear?

A

5-7 days post-procedure

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

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9
Q

What are the common clinical features of surgical site infections?

A
  • Spreading erythema
  • Localised pain
  • Pus or discharge from wound
  • Wound dehiscence
  • Persistent pyrexia
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10
Q

How deep are surgical site infections?

A

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

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11
Q

What investigations should be done in suspected SSI?

A
  • Wound swabs taken for culture at wound site

- Blood tests

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12
Q

When are wound swabs for culture particularly important in SSIs?

A

If purulent discharge is present

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13
Q

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

A

Wound edges (possible skin flora contamination)

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14
Q

What blood tests should be done in SSIs?

A
  • FBC
  • CRP
  • Blood cultures if evidence of systemic involvement or sepsis
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15
Q

What is involved in management of SSIs?

A
  • Remove sutures or clips

- Antibiotics

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16
Q

Why should sutures/clips be removed in SSIs?

A

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

17
Q

When can prevention of SSIs take place?

A
  • Pre-op
  • Intra-op
  • Post-op
18
Q

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

A
  • Prophylactic antibiotics if indicated
  • Do not remove hair routinely
  • Patient advice
19
Q

When should prophylactic antibiotics be given pre-op?

A
  • Clean surgery involving prosthesis

- Clean-contaminated or contaminated surgery

20
Q

How should hair removal be done if it is required?

A

Immediately prior to surgery with electric razor

21
Q

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

A
  • Shower prior to surgery
  • Encourage weight loss
  • Optimised nutrition
  • Good diabetic control
  • Smoking cessation
22
Q

What is involved in intra-op prevention of SSIs?

A
  • 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
23
Q

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

A
  • Monitor wounds closely
  • Ensure wounds in difficult areas are closely observed
  • Refer to tissue viability nurse if necessary
24
Q

What is the advantage of see-through dressings?

A

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

25
Q

What are the ‘difficult areas’ for wounds?

A

Skin creases and underneath skin folds

26
Q

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

A

Pads to separate the wound from overlying skin

27
Q

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

A

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

Peri-Operative Care [16] (20 decks)

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