Surgical Site Infection Flashcards
What is a surgical site infection (SSI)?
An infection that occurs in the incision created by an invasive surgical procedure.
What is the importance of SSI?
Leading cause of hospital morbidity - increasing ITU admission rates, doubling mortality rates, and increasing overall length of stay
What is the primary management of SSI?
Prevention
How are SSIs prevented?
- Good surgical technique
- Patient optimisation
What does the incidence of SSIs depend on?
Type of surgery and degree of contamination (clean, clean contaminated, contaminated, or dirty surgery)
What are the patient risk factors for SSIs?
- Extremes of age
- Poor nutrition status
- Diabetes mellitus
- Renal failure
- Immunosuppression
- Current smoker
What are the operation risk factors for SSIs?
- Preop shaving of site of incision
- Length of operation
- Foreign material in surgical site
- Insertion of surgical drain
- Poor closure of wound
When do the symptoms of surgical site infection typically appear?
5-7 days post-procedure
However can develop up to 3 weeks after, especially if prothesis
What are the common clinical features of surgical site infections?
- Spreading erythema
- Localised pain
- Pus or discharge from wound
- Wound dehiscence
- Persistent pyrexia
How deep are surgical site infections?
Most are superficial, but some may be deeper and can result in extensive wound breakdown
What investigations should be done in suspected SSI?
- Wound swabs taken for culture at wound site
- Blood tests
When are wound swabs for culture particularly important in SSIs?
If purulent discharge is present
What area should be avoided when taking wound swabs from SSIs?
Wound edges (possible skin flora contamination)
What blood tests should be done in SSIs?
- FBC
- CRP
- Blood cultures if evidence of systemic involvement or sepsis
What is involved in management of SSIs?
- Remove sutures or clips
- Antibiotics
Why should sutures/clips be removed in SSIs?
Allows for drainage of any pus and opportunity for wound packing if required
When can prevention of SSIs take place?
- Pre-op
- Intra-op
- Post-op
What is involved in the pre-op prevention of SSIs?
- Prophylactic antibiotics if indicated
- Do not remove hair routinely
- Patient advice
When should prophylactic antibiotics be given pre-op?
- Clean surgery involving prosthesis
- Clean-contaminated or contaminated surgery
How should hair removal be done if it is required?
Immediately prior to surgery with electric razor
What patient advise should be given pre-op to reduce risk of SSI?
- Shower prior to surgery
- Encourage weight loss
- Optimised nutrition
- Good diabetic control
- Smoking cessation
What is involved in intra-op prevention of SSIs?
- 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
What is involved in the post-op prevention of SSIs?
- Monitor wounds closely
- Ensure wounds in difficult areas are closely observed
- Refer to tissue viability nurse if necessary
What is the advantage of see-through dressings?
Limit number of dressing changes for observation thus minimising chance for bacterial contamination
What are the ‘difficult areas’ for wounds?
Skin creases and underneath skin folds
What may be required for wounds in skin creases/folds?
Pads to separate the wound from overlying skin
When might referral to a tissue viability nurse be useful post-op?
For advice on appropriate dressings for surgical wounds that are healing by secondary intention
