Surgical Site Infections

Question 1

What are the causes of post-op pyrexia

Answer 1

Wind (day 1): physiological response, atelectasis, pneumonia
Water (day 3): UTI
Wound (day 5): SSI, anastomotic leak
Walking (day 7): DVT/PE

Question 2

Which organisms cause surgical site infections

Answer 2

Staph. aureus (including MSSA and MRSA)
E. coli
Pseudomonas aeruginosa

Question 3

What are the levels of surgical site infections

Answer 3

Superficial Incisional: skin and subcutaneous tissues
Deep Incisional: fascial and muscle layers
Organ/Space Infection: any part of the anatomy other than the incision

Question 4

What are the pre-operative methods for preventing surgical site infections

Answer 4

Determine their risk (age, ASA score, co-morbs, medications, obesity, smoking)
Day of /day before surgery showering
Hair removal using an electric clipper on the day of the surgery
Nasal decontamination if carrying S. aureus
Abx prophylaxis

Question 5

What is the most powerful risk factors for surgical site infections following cardiothoracic surgery

Answer 5

Staph. aureus carriage in the nostrils

Question 6

What are the intra-operative management options to prevent surgical site infections

Answer 6

Limiting no. of people in theatre
Positive pressure
Sterilisation of surgical instruments
Skin prep: chlorhexidine in 70% alcohol
Maintain normothermia
Oxygenation >95%

Question 7

Why must normothermia be maintained in patients during surgery

Answer 7

Hypothermia → increase risk of SSIs by causing vasoconstriction and decreasing oxygen delivery to wound space with impairment of neutrophil function

Question 8

Epidemiology of surgical site infections

Answer 8

In 2011, 15.7% of HAIs were SSIs
Leads to an increased length of stay in hospital
Risk of SSIs is 5% in those undergoing surgery

Question 9

When is antibiotic prophylaxis indicated for surgery

Answer 9

Placement of prosthesis/valve
Clean-contaminated surgery
Contaminated surgery

Question 10

Management for surgical site infections

Answer 10

Mild (erythema, no fever)
Analgesia
Regular wound dressing changes
Oral antibiotics

Severe (discharge, fever, evidence of abscess)
Wound swabs
IV antibiotics
If abscess is present, reopening the wound for drainage and debridement
Allow wound to heal by secondary intention