Surgical Site infections in O&G TOG 2021

Question 1

Most common bacterial causing surgical site infection>

Answer 1

Staph aureus
Eterobacterales
E Coli
Proteus

Question 2

Definition of surgical site infection?

Answer 2

Superficial, deep or oragan/sapce occurring within 30 days if no implant left, or 1 within 1 year if an implant left.

Question 3

Difference in presentation from superficial, deep and organ/space infection

Answer 3

• Superficial: Purulent exudate, erythema, localised swelling, tenderness, heat
• Deep: Purulent exudate from deep wound incision, dehiscence, pyrexia, localised pain, abscess.
• Organ/space: Purulent exudate from drain, organism isolated from organ or space

Question 4

Explained wound classification
Clean
Clean contaminated
Contaminated
Dirty/infected

Answer 4

• Clean: sterile, no break steril technique – skin incision for cystectomy
• Clean contaminated: Sterile condition but resp/GI/gential/urinary tract is entered e.g. skin incision for hysterectomy or CS
• Contaminated: Major break in sterile technique, gross spillage from GI. Bowel injury
• Dirty/infection wound with devitalised tissue with organisms pre-existing before operation e.g. lap for pelvic infection

Question 5

Which surgery has highest risk of surgical site infection

Answer 5

Large bowel surgery

Question 6

Rate of surgical site infection
1) Generally
2) Abdo hysterectomy
3) CS

Answer 6

• SSI 2-6% surgery. Abdo hysterectomy around 2%. C/S 3-15%

Question 7

How to reduce risk of SSI

Answer 7

o Parental abx before starting
 EMCS Reduce wound infection 61%, endometritis 62%, serious maternal infection 69%
o MRSA sceening – consider nasal mupirocin and chlorhexidine body wash
o Skin prep – Alochol based e.g. chlorhexidine unless CI
o Pre-op skin wash – was on day/night before surgery
o Homeostasis – heat, glycaemic control, oxygenagtion
o Vaginal cleansing – 4% chlorhexidine/iodine before hysterectomy
o Hair removal – not routine, if needed
o Skin – continous, negative pressure in high risk
o Patient factors – reduce re-op – smoking/ETOH/wight/DM

Question 8

For CS, abdo hysteectomy, vginal hysterecomy what Abx recommdened? Non pen allergic & pen allergic

Answer 8

Same but can’t use IV co-amox in pregnancy

Question 9

If MRSA +ve what Abx to give?

Answer 9

Question 10

When to re-dose Abx?

Answer 10

> 3 hours
EBL >1500mls
Consider double dose if high BMI

Question 11

Risk of wound infection chlorhexidine vs iodine

Answer 11

C: 4%
Iodine 7.£

Question 12

How much does vaginal cleansing reduce risk of SSI

Answer 12

8% to 4%
If ROM 18% to 4%

Question 13

When do SSI most commonly present

Answer 13

4-7 days post op
. CT if no response after 48hrs Abx

Question 14

How common is necrotising fasciitis after CS

Answer 14

1.8/1000

Question 15

3 main types of necrotising fasciitis

Answer 15

o Type 1 Polymicroial
o Type 2 Group A Strep – most common in O&G
o Type 3 Gas gangrene/clostidial myonecrosis
- Type 2 more commin in immunosuprresion, DM, vascular insufficiency, chronic alcoholism

Penicillin G, Gent, Clinda - surgical debridement