| What are SSI? | Surgical site infection (SSI) is an unfortunate postoperative complication that affects many surgical patients worldwide and treatment of this type of wound is most likely to occur following discharge from the acute care setting.
prevalence of SSI and measuring the impact of prevention measures |
| How is epidemiology of SSI? | • Surgical site infection (SSI) is the third most commonly reported healthcare-associated infection (HCAI) and results in significant patient morbidity and mortality
• The risk of SSI is influenced by a number of intrinsic and extrinsic factors, particularly the number of microorganisms present at or introduced into the incision
• The risk of SSI increases with the age of the patient; other important risk factors are severe underlying illness and obesity
• Measuring and reporting rates of SSI in surveillance systems is an important strategy for determining
• Clinical definition of SSI: Infectious process present at the site of surgery.
• Clinical signs and symptoms of infection include heat, redness, swelling, elevated body temperature and purulent exudate from the wound or the drain. |
| How is classification of SSIs? | • CDC reporting definition for surgical site infection surveillance: infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site.
• According to the range of affected tissues SSI can be superficial, deep or organ/space. |
| Image of SSIs? | . |
| What are clinical sx of superficial SSIs? | . |
| What are sx of deep SSIs? | . |
| What are clinical sx of organ SSIs? | . |
| What are factors in SSIs? | Host/patient (underlying diseases, obesity, age)
Microorganisms (number virulence)
surgical procedure (duration, type technique) |
| What are classes of surgery? | Clean, clean contaminated, contaminated, dirty/infected |
| What is clean surgery? | Uninfected operative wounds in which inflammation is not encountered, and the respiratory, gastrointestinal, genital, urinary tracts or the oropharynx are not entered, and there is no break in aseptic technique.
In addition, clean wounds must be primarily closed
and, if there is drainage, this must be closed.
Includes operative wounds that follow nonpenetrating trauma, e.g. fractured neck of femur, providing they meet these criteria. |
| What is clean contaminated surgery? | Operative wounds in which the respiratory,
alimentary, genital, or urinary tracts are entered
under controlled conditions and without unusual
contamination, providing that there is no evidence
of infection or a major break in aseptic technique.
Note: procedures that do not enter one of these
body tracts cannot be clean contaminated e.g.
orthopaedic procedures |
| What is contaminated surgery? | Operations on fresh, open traumatic
wounds;
or operations where there is a major break in
aseptic technique;
or operations in which there is gross spillage from the gastrointestinal tract; or acute inflammation without pus is encountered |
| What is dirty surgery? | Operations in which acute inflammation with pus is
encountered,
or in which perforated viscera are found;
operations on traumatic wounds, which have retained
devitalised tissue, foreign bodies or faecal
contamination,
or where the operation on the traumatic wound has
been delayed.
Operations included in this class are those in which the
organisms causing postoperative infection are likely to
have been present in the operative field before surgery |
| What is SSI risk index? | Each operation is scored by the presence or absence of three risk factors at the time of surgery:
1. American Society of Anaesthesiologists’ (ASA) preoperative assessment score of 3 or more (this indicates the patient has a severe underlying systematic disease)
2. Operation is classified as contaminated or dirty
3. Operation lasts for more than a specific period of time (‘T hours’), where T is the 75th percentile of the duration of surgery and depends on the surgical procedure being performed (e.g. hip replacement T time=2 hours)
Each of the risk factors described above contributes one point to the risk index score, which ranges from 0 (none of the risk factors present) to 3 (all of the risk factors present |
| What are principles of wound management? | Lifestyle (smoking, nutrition)
Pre-existing patient related factors (DM, obesity, depression, COPD, PAD, immunodeficiency)
Intraoperative factors (procedure duration, tissue oxygenation, class of surgery, intraop body temperature, method of closure, surgeon level of experience) |
| What are factors improving home care management of surgical wounds? | Multidisciplinary approach
Consistency in care
Patient centered wound care plan with clear and well described guidance with appropriate management goals
Access to appropriate dressing resources and clinical expertise
Patient and carer education
Written and oral information |
| What are factors improving outcomes across in patient and out patient settings? | Consistent communication and forwarding of medical reports
Clear responsibility roles
Education of patients and health care professionals
Working/functional national guidelines and standards comprising out- and inpatient sectors |
| What are periop practice to prevent SSIs? | Before surgery, patients should shower (full body) with soap the night before and the day
of the operation
The incision site should be prepared with an alcohol-based antiseptic solution and hair removal should be avoided
Antimicrobial prophylaxis should be administered only when indicated based on published clinical practice guidelines
Normothermia should be maintained in all patients undergoing surgery
Strategies to ensure glycaemic control should be in place
Intraoperative factors such as tissue oxygenation, intraoperative warming and type of sutures may also influence the occurrence of SSI
Measuring and reporting rates of SSI in surveillance systems is important practice for determining prevalence and incidence of SSI. |
| What are different types of wound dressings? | Advanced (interactive, alginates, polyurethane, hydrogels...)
Bacteria and Fungi binding dressings (iodine, silver, PHMB...)
Advanced (active, negative pressure wound therapy)
Basic wound contact layers (low adherent, absorbant) |
| What are prinicples of Postop care | • Wounds should be covered with a protective dressing
for at least 48 hours
• Wound dressings are only a part of the postoperative
management of wound
• Postoperative management includes assessment of
patient related lifestyle factors, comorbidities and risk
of complications
• Use aseptic technique at all times
• Surgical wounds healing by secondary intention should
be managed by health professionals with tissue viability
expertise and dressed with appropriate dressings |
| What is aseptic technique? | . |
| How is wound assessment and dx? | • Clinical signs of SSI include heat, redness, swelling, elevated body temperature and purulent exudate from the wound or the drain
• Early diagnostics of comorbidities and treatment of ischaemia can decrease the number of surgical site complications
• Important to sample for microbiological diagnostics
• Pus and biopsy samples enable the use of microscopy and additional diagnostic methods, including molecular tests |
| How is swab of wound? | Z swabbing (The swab should be rotated between the fingers as the wound is swabbed from margin to margin in a 10-point, zigzag fashion)
Levine Method Swab Culture |
| How is tx of SSI? | . |
