Surgical Site Infections Flashcards
What are SSIs?
Surgical Site Infections
Infections occurring in wound created by invasive surgical procedure
What are SSIs responsible for?
20% of Healthcare Adverse Incidents
5% of patients who have undergone surgery
Disadvantages of SSIs:
Can double length of hospital stay - unpleasant + expensive
High morbidity - unwell + even mortality
Types of SSIs:
Wound discharge
Dehiscence
Lymphadenitis
Formation of abscesses
Necrosis
Spread to deeper tissue
Sepsis
Possible consequences of SSIs:
Microbial penetration of deeper tissues
Invasion of bloodstream (bacteraemia, sepsis)
Spread of bacteria to other sites
What is involved in causing SSIs?
Contamination of incision by normal microbiota
Damage to tissues / blood vessels
Foreign bodies (e.g. sutures, implants)
Reduced efficacy of inflammatory response
What are the different classifications of surgical wounds?
Clean (class I)
Clean / contaminated (class II)
Contaminated (class III)
Dirty (class IV)
Clean wound:
Elective surgery
No acute inflammation
Do not involve respiratory, gastro-intestinal or genitourinary tracts
What’s the genitourinary system?
Organs of reproductive and urinary system
Clean / contaminated wounds:
Urgent / emergency case
Clean wounds with higher risk of infection
Uncomplicated respiratory, gastrointestinal and genitourinary tract surgery
Contaminated wounds:
Outside object comes into contact with wound
Large amounts of spillage from GI tract into wound
Dirty wound:
Purulent inflammation
Foreign object lodged in wound
Traumatic or infected wounds
What is meant by antibiotic prophylaxis?
Antibiotics given as a preventative treatment
Microbial causes of SSIs from skin:
Staphylocossus aureus
Microbial causes of SSIs from bowel:
E.coli
When is antibiotic prophylaxis given before?
Clean surgery (prosthesis or implant only)
Clean-contaminated surgery
Contaminated surgery
WhaWhat must surgical team do during intraoperative care?
Hand decontamination
Wear sterile gown and 2 pairs sterile gloves
What must happen to patient during intraoperative care?
Prepare skin at surgical site immediately before incision
Maintain homeostasis
Cover incisions with appropriate dressing at end
How do you disinfect hands of ward staff?
Non-antimicrobial soap + water
Alcohol based hand rub
How do you disinfect hands of surgical team?
Scrub with aqueous antiseptic surgical solution before first operation
If not visibly soiled, subsequently use alcohol based hand rub or antiseptic surgical solution
How do you disinfect patient’s skin?
Alcoholic chlorhexidine
Providone iodine
What dressings are used to prevent infection?
Conventional dressings
Occlusive dressings
What must be used in postoperative care?
Appropriate dressings
Aseptic or non-touch technique to change or remove dressings
Sterile saline for wound cleansing up to 48hs after surgery
What shouldn’t be used in postoperative care?
Topical antimicrobial agents for wound healing by primary intention
Ho can you reduce the risk of postoperative infection after surgery?
Good nursing - prevent pressure sores
Arrange active physiotherapy to minimise risk of URTIs and UTIs
How can you prevent catheter-related infections?
Always wash hands before procedure
Wear gloves when handling catheter
Use antiseptic wipe
Cover insertion site with dressing
What may an EARLY prosthetic joint infection look like?
< 1 month
Fulfilment with wound sepsis
What may a DELAYED prosthetic joint infection look like?
< 1 year
Indolent, low grade infection
What may a LATE ONSET prosthetic joint infection look like?
> 2 years
Septic arthritis
What are risk factors of prosthetic joint infections?
Rheumatoid arthritis
Diabetes mellitus
Malnutrition
Obesity
