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Surgical Site Infection

Surgical site infection is defined as an infection occurring within 30 days of a surgical procedure involving tissues exposed during surgery. Infections are classified as superficial, deep, or organ/space depending on the involved tissue layers. Risk factors include poor nutrition, diabetes, immunosuppression, foreign materials, and poor surgical technique. Prevention strategies include pre-op glycemic control and antibiotics, maintaining a sterile operating room, and proper post-op wound care. Treatment involves debridement, irrigation, dressings, antibiotics, and closure by secondary intention if needed.

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117 views6 pages

Surgical Site Infection

Surgical site infection is defined as an infection occurring within 30 days of a surgical procedure involving tissues exposed during surgery. Infections are classified as superficial, deep, or organ/space depending on the involved tissue layers. Risk factors include poor nutrition, diabetes, immunosuppression, foreign materials, and poor surgical technique. Prevention strategies include pre-op glycemic control and antibiotics, maintaining a sterile operating room, and proper post-op wound care. Treatment involves debridement, irrigation, dressings, antibiotics, and closure by secondary intention if needed.

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VLSI TECHNOLOGIES
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SURGICAL SITE INFECTION

DEFINATION: infection of tissues ,organs or spaces exposed by surgeons


during perfomance of an invasive procedure

CLASSIFICATION:

CDC DEFINATION (ACCORDING TO DEPTH)

SUPERFICIAL SSI :

 infection with in 30 days after surgery


 involves skin and subcutenous tissue only
 plus one of the following
o purulent discharge
o diagnosis of superficial ssi by surgeon
o erythema , pain oedema .

DEEP INCISIONAL SSI:

 infection with in 30 days after surgery without implant or within


14 year after surgery with implant
 involves fascia and muscle and one of the following
o purulent discharge from deep space
o abscess in deep space
o diagnosis by a surgeon
o fever , pain , tenderness leading to dehisence
o
ORGAN SPACE SSI :

 infection with in 30 days after surgery without implant or within


14 year after surgery with implant
 involves any organ space opened or manipulated with one of the
follwing
o purulent discharge from drain placed in organ space
o cultured organisms from fluid aspirated from organ space
o absecess found in organ space
o diagnosis by a surgeon

CLASSIFICATION OF SURGICAL WOUNDS

1.CLEAN WOUNDS: operative procedure does not cater into normally


colonised viscera

2. CLEAN CONTAMINATED : elective controled entry into normal


colonised viscus

3.CONTAMINATED : gross contamination at surgical site without


obvious infection

4. DIRTY : surgical procedure performed when there is active infection

SOURCE OF SURGICAL INFECTION (SSI)

A. ENDOGENOUS : present in or the host

eg. ssi from contamination of wound of perforated appendix


B. EXOGENOUS : acquired from outside like OT or ward ( hosputal
acquired infection)

FACTORS DETERMINING WETHER A WOUND WILL GET INFECTED

1. host response
2. virulence and inoculum of infective agent
3. vascularity of tissue
4. presence of dead or foreign tissue
5. presence of antibiotics during decisive period ( upto 4 hours
before bacterial growth becomes esthabilished enough to cause
infection

RISK FACTOR FOR WOUND INFECTION


1. malnutrition ( obesity or wiight loss)
2. metaboliv diseases( t2dm, uremea, jaundine)
3. immunosuppression
4. colonization and translocation in GIT
5. poor perfusion
6. foreign body material
7. poor surgical technique
NATIONAL NOSOCOMIAL INFECTION SURVEILLEINCE
SYSTEM:SSI RISK INDEX
1. Wound Classification(Cantaminated Or Dirty):1
2. ASA OF 3, 4, 5:1
3. duration of surgery exclude 75th percentile of T
point:1

CLINICAL FEATURE OF SSI


1. occurs 5 to 6 days post operatively
2. 80 to 90 percent occurs within 30 days
3. erthema, tenderness, purulent discharge
4. wound dehisence can occur
5. wound diarrhea can occur

ORGANISM

 major cause: staphylococcus aureas


 GI surgeries: E COLI
 others : like streptococcus , enterococcus , pseudococcus,
klebsiella

SCORING SYSTEM FOR SSI

1. SOUTHAMPTON WOUND SCORING SYSTEM


2. ASPESIS WOUND SCORE
PREVENTION OF SSI

A pre operative :

1. stop smoking
2. decrease weight if obeses
3. glycemic controlin type 2 DM
4. nutritional suppliments
5. bowel preparation
6. wean of corticosteriods
7. antibiotic prophylysis.

B. INTRAOPERATIVE.
1. OT should be maintained at positive pressure of
2. minimise movement in and out of ot
3. sterilization of surgical instruments
4. cleaning the environmental surface
5. surgical mask to worn, sterile gloves
6. excellent surgical technique.

C. POST OPERATIVE

1. antibiotic coverage
2. wound care.
TREATMENT OF SSI

 skin suture or stapler over the infection is removed and pus is


drained
 if fascia is intact than debridement of non vitalized tissue is done
 thorough saline irrigation of base the wound
 regular dressing
 iv antibiotics
 delayed primary closure or healing by secondary intention

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