Surgical Site Infections Flashcards
What is a surgical site infection?
An infection occurring in a wound created by an invasive surgical procedure.
Name some examples of surgical site infections
Wound discharge, Dishiscence Lymphadenitis, Formation of abscesses, Necrosis, Gangrene, Spread to deeper tissue and Sepsis
What are the possible consequences of SSIs
Microbial infection penetrating into deeper tissue, Invasion into bloodstream (bacteraemia and sepsis)
and the spread of infection to other sites like heart valves and bones ect
Why do SSIs occur?
Whn normal microbiota contaminates incision, there is damage to tissue or blood vessels, presence of foreign bodies or reduce efficiency of inflammatory response
What factors influence the development of SSIs
Type of surgical wound, The pre, intra and postoperative care, Surgical team, Age and health of patient, Infection prevention procedures, Presence of foreign bodies/prosthetics, Duration of surgery, Position of patient on operation list.
What are the classifications of surgical wounds?
Class I (clean) - Elective surgeries with no acute inflammation and don't involve respiratory (R), GI or genitourinary (GU) tracts Class II (clean/contaminated) - Urgent/emergency cases that have clean wound but higher risk of infection such as R, GI or GU tract surgeries. Class III (contaminated) - Outside objects come into contact with wound or large amounts of GI spillage into wound Class IV (dirty) - Purulent inflammation (pus), foreign object lodged in wound or traumatic/infected wounds.
What decreases the chance of an SSI?
Antibiotic prophylaxis (however doesn’t decrease the risk in class I wounds)
What are microbials from the skin cause SSIs?
Staphylococcus aureus
Streptococci ssp
Enterococci spp
What microbials from the bowel cause SSis?
Escherichia coli, Bacteroides Fragilis Clostridium Perfringens Enterococci spp Anaerobolic cocci
Describe some of the preoperative care that reduces SSIs
Preoperative showering, Clipping hair rather than shaving, Antibiotic prophylaxis, and not routinely using nasal decontamination or mechanical bowel preparation.
Describe some intraoperative care that reduces SSIs
Surgical team hand decontamination, and sterile gowns and two pairs of sterile gloves, do not use non-iodophor-impregnated incise drapes, prepare skin at surgical site immediately before incision, maintain patient homeostasis, Do not use wound irrigation or intracavity lavage, Do not use intraoperative disinfection or topical antibiotics, cover incisions with appropriate dressings.
Who should be disinfected to prevent SSIs?
Hands of ward staff - ABHR or non-microbial soap
Hands of surgical team - scrub with antisepitc surgical solution, if not viably soiled us ABHR or surgical solution.
Patient’s skin - alcohol chlorhexidine and povidone iodine
Name some dressings that avoid SSIs
Conventional - Gauze, Tulle gras (medicated) and non-adhesive fabrics
Occlusive - hyrdocolloids, plyurethane films and foams
Describe the postoperative care that prevents SSIs
Appropriate dressings, aseptic or non-touch techniques to change/remove dressings, sterile saline for wound cleansing up to 48hrs postoperative, no use of topical antimicrobial agents for wound healing by primary intention, following guidance regarding use of debriding agents.
Name ways the risk of SSIs is reduced
Preoperative stay to minimum, treat current infections before surgery, keep length of stay as small as possible, maintain good operative techniques, debridement of necrotic and dead tissue, establish a good blood supply, prevent pressure sores, arrange active physiotherapy to minimise URTIs and UTIs
