Surigical Site Infection (SSI) Flashcards
What is an SSI?
An infection related to an operative procedure that occurs at or near surgical incision within 30 days of procedure or within 90 days of insertion of prosthetic material.
*can be localised to infection site or extend into deep tissue
What are endogenous sources of infection?
*bacteria translocation to sterile site
*GI tract spillage during surgery
What are exogenous sources of SSI?
*surgical team
*surgical instruments
*theatre environment
What are patient related risk factors?
*obesity
*immunisuppressed
*malnutrition
*smoker
*extremes of age
What are operation related risk factors of SSI?
*implants
*surgical drains
*surgical technique
*type of surgery
*prolonged surgery
What is surgical antibiotic prophylaxis?
The use of antibiotics to prevent infectious complications at surgical site
What are the operation classifications?
*clean-no break in aseptic operating- SAP usually not required if non-prosthetic/implants
*clean-contaminated- operations on GI tract, respiratory, genitourinary tracts but no significant spillage- SAP needed
*contaminated- visible contamination of wound-gross spillage-open injuries operated on within 4 hours (appendectomy)- SAP needed
*dirty- operations in presence of pus-or injuries opened >4 hours- SAP needed and post op doses
When is surgical prophylaxis given?
One dose within 60 mins before knife to skin.
When is an intraoperative redose required?
*when duration of procedure exceeds two half lives of antimicrobial
*excessive blood loss (>1500ml I’m adults)
*after dirty surgery or infected wounds
What are symptoms of SSI?
*red, inflamed wound
*pus from incision site
*swelling of incision site
*hot to touch
*pain
What are laboratory indicators off SSI?
*^ WCC
*^CRP
*positive swab
What are ideal antibiotic characteristics?
*covers against expected organisms
*low toxicity
*cost effective
*ensure tissue conc remains above MIC for pathogens at time of incision and throughout procedure
What should you consider when choosing a SAP?
*penicillin allergy
*MRSA positive- Methicillin-resistant Staphylococcus aureus
*Clostridioides difficile risk- clindamycin, fluoroquinolones
How is MRSA screened?
*nasal swab
*broken or non-intact skin swab
*sputum if cough produces
If positive- consider decolonisation
What is MRSA decolonisation therapy?
*octenisan solution for 5 days
*bactroban (mupirocin) nasal ointment twice daily for 5 days- use sterile cotton wool bud
*Naseptin in mupirocin resistant MRSA- 4 times daily for 10 days
*change clothing and bedding daily
