Surgical Site Infections

Question 1

What are SSIs?

Answer 1

1- Surgical site infections
2- Occur in wounds treated by invasive surgical procedures
3- Responsible for ~20% of HCAIs
4- Can double length of hospital stay
5- Associated with high morbidity

Question 2

What percentage of patients undergoing surgery develop an SSi?

Answer 2

5%

Question 3

What are the eight types/examples of SSIs?

Answer 3

1- Wound discharge
2- Dehiscence
3- Lymphadenitis
4- Formation of abscesses
5- Necrosis
6- Gangrene
7- Spread to deeper tisue
8- Sepsis

Question 4

What are the possible consequences of SSIs?

Answer 4

1- Microbial penetration into deeper tissue
2- Invasion of bloodstream leading to bacteraemia and sepsis
3- Spread of bacteria to other sites like the heart valves, bones or peritoneum

Question 5

How, when and why can SSIs occur?

Answer 5

1- Contamination of incision by normal microbiota
2- Damage to tissues
3- Damage to blood vessels
4- Presence of foreign bodies such as sutures or implants
5- Reduced efficacy of inflammatory response
6- May occur before, during or after surgery

Question 6

What factors influence the development of SSIs?

Answer 6

1- Type of surgical wound
2- If wound is clean or dirty
3- Preoperative, intraoperative and postoperative care
4- Surgical team
5- Age and general health
6- Extent of tissue injury
7- Infection prevention procedures
8- Presence of prosthesis or foreign body
9- Presence or absence of drain
10- Duration of surgery
11- Place in operation list

Question 7

What are the four classes of surgical wounds?

Answer 7

1- Class I: clean
2- Class II: clean/contaminated
3- Class III: contaminated
4- Class IV: dirty

Question 8

Describe a class of I wound

Answer 8

1- Clean
2- Elective surgery
3- No acute inflammation
4- Does not involve respiratory, gastrointestinal or genitourinary tracts

Question 9

Describe a class II wound

Answer 9

1- Clean/contaminated
2- Urgent or emergency case surgery
3- Clean wounds with higher risk of infection
4- Uncomplicated R, GI or GI tract surgery

Question 10

Describe a class III wound

Answer 10

1- Contaminated
2- Outside objects may have come into contact with wound
3- Large amounts of spillage from GI tract into wound

Question 11

Describe a class IV wound.

Answer 11

1- Purulent (pus filled) inflammation
2- Foreign object may be lodged in wound
3- Traumatic or infected wound

Question 12

What is antibiotic prophylaxis?

Answer 12

Antibiotics given before surgery

Question 13

What is the microbial load of class I wounds at time of surgery?

Answer 13

Less than 10 cfu/ml

Question 14

What is the microbial load of class II wounds at time of surgery?

Answer 14

20-40 cfu/ml

Question 15

What is the microbial load of class III wounds at time of surgery?

Answer 15

1000-1500 cfu/ml

Question 16

What is the microbial load of class IV at time of surgery?

Answer 16

More than 3500 cfu/ml

Question 17

What are the most common microbial causes of SSIs?

Answer 17

1- Staphylococcus aureus 
2- Streptococci spp.
3- Enterococci spp.
4- Echerichia coli
5- Bacteroides fragilis
6- Clostridium perfringes
7- Eterococci sp.
8- Anaerobic cocci

Question 18

What does preoperative care include?

Answer 18

1- Preopeative showering
2- Hair should not be removed but clipped
3- Give antibiotic prophylaxis before class I, II and II surgery
4- Nasal decontamination should not be routinely done
5- Mechanical bowel preparation should not be routinely done

Question 19

What does intraoperative care include?

Answer 19

1- Surgical team should decontaminate hands
2- Non-iodophor-impregnates incise drapes should NOT be used
3- Sterile gown and two pairs of sterile gloves
4- Skin at incision site should be prepared immediately before incision
5- Homeostasis maintained
6- Wound irrigation or intracavity lavage should not be used
7- Inntraoperative disinfection and topical antibiotics should not be used
8- Incisions should be covered with appropriate dressing at the end

Question 20

How should the hands of ward staff be disinfected?

Answer 20

1- Washed with non-antimicrobial soap and water

2- ABHR should be used

Question 21

How should the hands of the surgical team be disinfected?

Answer 21

• Scrubbed with aqueous antiseptic surgical solution before first operation
  2- If hands are not visibly soiled, ABHB or antiseptic surgical solution should be used

Question 22

How should the patient’s skin be disinfected?

Answer 22

Alcoholic chlohexidine

Providone iodine

Question 23

What are the two types of dressings?

Answer 23

1- Conventional

2- Occlusive

Question 24

What are three examples of conventional dressings?

Answer 24

Gauze

Tulle gras

Non-adhesive fabrics

Question 25

What are the three examples of occlusive dressings?

Answer 25

Hydrocolloids

Polyurethane films

Foams

Question 26

What does postoperative care include?

Answer 26

1- Use appropriate dressing
2- Use aseptic or non-touch technique to change or remove dressings
3- Sterile saline should be used to cleanse wound 48 hours after surgery
4- Topical antimicrobial agents should not be used for wound healing by primary intention
5- Debriding agents guidance must be followed

Question 27

How can the chances of postoperative risks be reduced?

Answer 27

1- Preoperative length of stay in hospital kept to a minimum
2- Any current infections should be treated before surgery
3- Length of surgery should be kept to a minimum
4- Good operative technique must be maintained
5- Dead and necrotic skin must be removed
6- Good blood supply must be established
7- Good nursing to prevent bed sores
8- Active physiotherapy to prevent URTIs and UTIs

Question 28

How can catheter-related infections be prevented?

Answer 28

1- Wash hands before procedure
2- Wear gloves
3- Use single use antiseptic wipe
4- Cover insertion site with dressing

Question 29

What risk factors encourage the development of prosthetic joint infections?

Answer 29

1- Rheumatoid arthritis
2- Diabetes mellitus
3- Malnutrition
4- Obesity

Question 30

How can prosthetic joint infections be diagnosed?

Answer 30

1- Blood culture
2- Collection of pus by needle aspiration
3- Bone biopsy
4- Raised ESR and CRP
6- Polymorphonuclear leucocytes
7- Radiological imagine