Surgical Site Infections

Question 1

What does HCAI stand for

Answer 1

Health care associated infection

Question 2

Define a surgical site and surgical site infection

Answer 2

A surgical site is the incision or cut in the skin made by a surgeon to carry out a surgical procedure and tissue handled or manipulated during the procedure. A surgical site infection occurs when micro organisms get into the part of the body that has been operated on and multiply in the tissues.

Question 3

What are some basic clinical indicators of infection

Answer 3

Pain, redness, heat, stinky

Question 4

What is the rough incidence of SSIs and how common are they as part of the overall healthcare associated infections

Answer 4

2.6% of all operations (some particular ones have a higher incidence)
3rd most common HAI

Question 5

What are the classifications of surgical site infections

Answer 5

Superficial incisionsal SSI - skin, subcutaneous tissue
Deep incisional SSI - Deep soft tissue (fascia and muscle)
Organ/space SSI - Organ/space

Question 6

What is the relative risk of SSIs dependent on the types of surgery

Answer 6

Clean - <2%
Clean-contaminated - 5-15%
Contaminated - 15-30%
Dirty - >30%

Go over the types of surgery

Question 7

Which types of procedure carry the most risk of SSIs

Answer 7

Large bowel surgery

Small bowel surgery

Question 8

Which infections carry the most serious implications

Answer 8

Ones with indwelling devices such as orthopaedic transplants, implants, indwelling devices etc. This is due to the potential of biofilms forming on these devices

Question 9

What impact does the length of a procedure have on the likelihood of infection

Answer 9

The longer the procedure, the higher the risk of SSIs

Question 10

What impact does BMI have on the likelihood of developing an SSI

Answer 10

Generally, the higher the BMI, the greater the chance of developing an SSI. This is particularly true in bowel surgeries

Question 11

Name some common SSI causing organisms

Answer 11

Staphylococcus aureus
MSSA 
MRSA
Enterobacteriales
Pseudomonus spp.
CoNS
Streptococcus spp.
Enterococcus spp.

Question 12

Name some surface proteins found on staphylococcus aureus

Answer 12

Coagulase, protein A (virulence factors)
Elastin binding protein - enables it to attach to tissues
Collagen binding protein - adhesion?
Fibronectin binding protein
Clumping factor
Enterotoxin B - associated with TSS (not usually a cause for SSIs)

Question 13

Give 7 ways we try to reduce the incidence of SSIs

Answer 13

Surveillance - keeping an eye on infection rates on a large scale (while hospitals, districts etc)
Prophylactic antibiotics - preventative antibiotics ONLY USED IN SOME SPECIFIC SURGERIES
Aseptis - avoiding microorganisms entering a given environment
Preparation of incision site - clippers, antiseptics
Warming - keeping the body temp warm can reduce risk of infection. Keeps the immune system functioning well
Oxygenation - reduced oxygen intake while under anaesthetic reduces function of the immune system
Glucose control - (relates to diabetes mostly)

Question 14

What is antibiotic prophylaxis

Answer 14

The administration of antibiotics before surgery to try to reduce the likelihood of bacterial infection

Question 15

When would the practice of antibiotic prophylaxis occur

Answer 15

Prior to:
clean surgery involving the placement of a prosthesis or implant
Clean contaminated surgery
Contaminated surgery

(Not before clean, non prosthetic uncomplicated surgery)

Question 16

Which antibiotics are used for antibiotic prophylaxis

Answer 16

Based in the local antibiotic formulary (potential for adverse effects are also taken into account)

Question 17

How are preoperative antibiotics administered

Answer 17

Administered as a single dose of antibiotic prophylaxis intravenously on starting anaesthia. However, they may be given earlier as prophylaxis for operations in which a tourniquet is used (as the delivery to that area will be decreased due to decreased blood flow)

Question 18

What is the time window before surgery where antibiotics can be administered which will reduce the risk of SSIs

Answer 18

2 hours

Question 19

Why do we remove hair before surgery

Answer 19

Improved view and access

Perceived reduction rate of infection

Question 20

Why is it not recommended to shave the hair before surgery (but to clip it instead)

Answer 20

Because razors damage the skin - they create micro abrasions and can disrupt organisms living in sweat glands etc potentially increasing SSI rate

Skin damage -> bacterial increase on skins surface

Question 21

What are chlorhexidine alcohol and providone iodine and why are they used

Answer 21

They are surgical site antiseptics (not antibiotics!) and are used to sterilise the incision area.
It seems chlorhexidine is more effective as it sticks to the skin well.
They are used for clean contaminated surgery

Question 22

What must be confirmed before the start of surgical intervention (out loud by medical staff)

Answer 22

Patient name and ID
What procedure, site and position are planned
How much blood loss is anticipated
Any specific equipment requirements
What monitoring/ support is required
*has SSI bundle been performed*
- antibiotic prophylaxis in last 60 mins
- glycaemic control 
- patient warming
-hair removal

Has vte prophylaxis been performed
Is essential imaging displayed