Surgical Site Infection

Question 1

Risk factors

Answer 1

Extremes of age

Poor nutritional state

DM, Renal failure, immunosuppression

Current smoker

Pre-operative shaving or site of incision

Length of operatio

Foreign material in surgical site

Insertion of surgical drain

Poor closure of wound

Question 2

Clinical features

Answer 2

Usually appear 5-7 days post-procedure but can take as long as 3 weeks after.

Spreading erythema

Localised pain

Pus or discharge from the wound

Wound dehiscence

Persstent pyrexia

Question 3

Investigations

Answer 3

Wound swabs for culture

Blood tests for infection markers FBC, CRP

Blood cultures if evidence of systemic infection

Question 4

Management

Answer 4

Sutures or clips present should be removed to allow drainage of pus.

Wound pack if required

Empirical abx should be started as per local guidelines.

Question 5

Prevention pre-op

Answer 5

Give prophylactic abx if indicated

Do not remove hair routinely (if necessary do this immediately prior to surgery with an electric clipper)

Patient advice about shower prior, encourage weight loss, optimised nutrition, good diabetic control, smoking cessation

Question 6

Intra-OP prevention

Answer 6

Prepare the skin immmediately before the incision using an antiseptic preparation like povidone-iodine or chlorhexidine.

Change gloves or gowns if contaminated

Use an appropriate interactive dressing at the end of the operation to cover all surgical incisions.

Question 7

Post-OP prevention

Answer 7

Monitor wounds closely (see-through dressings can help limit number of dressing changes required)

Ensure that wounds in difficult areas such as skin creases and underneath skin folds are closely observed.

Refer to a tissue viability nurse for advice on appropriate dressings for the management of surgical wounds that are healing by secondary intention.