What are surgical site infections

What is a surgical site infection?

A surgical site infection (SSI) is an infection that occurs on the part of the body where the surgery was performed. These infections can be minor or major involving deep tissues in the skin, depending on their impact to the body. There is a 2-4% chance for patients to undergo SSI after surgical procedures. In this article, we will talk about the common signs and symptoms of SSI so it can be better managed to reduce morbidity and hospital costs.

 

What is the most common cause of surgical site infections?

There are internal and external factors that can cause SSI. Some external factors include:

• Bacteria prior to surgery could enter the wound.
• Germs from the operation theater or while entering the hospital.
• Medical instruments being used by the medical staff are not properly sanitized.

The internal factors that can cause SSI include:

• Having a chronic medical condition such as diabetes, high blood pressure, cholesterol.
• Being categorized as obese or overweight.
• Having a weak immune system.
• High frequency in smoking or drinking.
• Being an elder.
• Having surgery up to 2 hours or longer.

What are the symptoms of SSI?

Some common symptoms include redness, swelling, higher body temperature resulting in fever, pus inside or outside the wound, slow healing, and sensitivity to touch. These symptoms arise within the first 30 days of surgery. If any of these symptoms are present, contact your doctor immediately in order to prevent a worsening of infection.

 

What are the three types of SSI?

According to “Best Practice Recommendations for the Prevention and Management of Open Surgical Wounds” by Orsted Heather, there are three types of SSI that can occur on the skin after
surgery.

These are categorized into three main sub-groups: Superficial Incisional, Deep Incisional, and Organ or Tissue related. The following table provides more information on the category, time, symptoms, and urgency of each SSI.

Category	Time	Symptoms	Urgency
Category 1 – Superficial Incisional: Takes place on the top layer of the skin or on the subcutaneous tissue, which is right under the first layer of the skin.	Happens within 30 days of the surgery.	Draining of pus Increased pain Excessive swelling High temperature or redness	Can be operated easily by a surgeon and does not require special attention such as extensive medical equipment.
Category 2 – Deep Incisional: Occurs in the deep tissues of the body including muscle tissue.	Takes place within 30 days to one year of surgery, depending on any fixation of implants.	Fever greater than 38°C. Evidence of infection found during re-operation or any other medical examination that involves radiology such as Computed Tomography (CT) Scan.	Must be diagnosed by a doctor and needs to be operated on right away in order to avoid any damage to muscles in the body.
Category 3 – Organ or Tissue: Occurs in any part of the body that was affected by the surgery, either intentionally or unintentionally.	Occurs within 30 days to one year of surgery.	Draining of pus through any internal organs. Evidence of infection is found during any medical exams performed by specialists.	Requires immediate attention and surgery or it can cause extreme damage to organs and surrounding area of the patient.

It is crucial to know which type of SSI has taken place for the patient so that appropriate care can be provided. Neglecting an SSI has life-warning risks which can lead to death. 

 

What are some risk factors of SSI?

Regardless of how cautious we are, there are always risk factors that increase the likelihood of acquiring an SSI. Some dynamic and static risk factors that hinder the ability to prevent an SSI include age, history of radiation on skin, obesity, blood sugar level, medications that suppress the immune system, proper ventilation of the operation theater, and in depth sterilization of surgical instruments.

 

How are surgical site infections treated?

There are both simple and complex processes to treat an SSI. The most simple and common method is to treat an SSI with antibiotics. A more complicated approach to treating these infections is through another surgical treatment. Surgeons perform the following actions to ensure that the wound has been accurately treated:

1. Open the wound by removing the accents that were placed on it. For example, staples or stitches.
2. Take a sample of the pus or tissue and perform a test of the sample. This informs the surgeon which of the three infections it could be and how to properly treat it.
3. Clean and rinse the wound by removing any infected tissue around it.
4. Drain any excess pus surrounding the wound.
5. Wrap the wound in a saline solution dressing.

 

What antibiotics are used to treat surgical site infections?

As mentioned earlier, the most common type of treatment for SSI is antibiotics. Some variations of antibiotics include intravenous antibiotics (IV) or pills. IV antibiotics are taken directly into the bloodstream through a pipe placed inside our veins.

There are two instances where different antibiotics are used. For surgeries under 48 hours, patients are prescribed Penicillin, Cefazolin, and Vancomycin. For surgeries over 48 hours, patients are prescribed Cefazolin, Clindamycin, and Vancomycin.

 

How should we take care of our own SSI?

When a surgical procedure was performed for the SSI, there are some steps to follow for wound care:

1. Wear gloves or wash your hands.
2. Remove old bandages.
3. Clean the infected area with saline solution.
4. Put on a new dressing.
5. Repeat steps every two to three days, depending on the severity of your wound.

 

How do we prevent SSIs?

Patients can stop SSIs by being proactive and performing aftercare.  

Here are some preventative measures we can take prior to surgery to avoid SSI:

1. Alert your doctor about chronic health problems such as diabetes, obesity, allergies.
2. Limit or stop use of tobacco and alcohol, which leads to a faster healing process.
3. Avoid shaving near the surgery area , which causes irritation to the skin and raises a higher risk of potential infection.
4. Shower with antiseptic soap. This removes any pre-existing germs on your body.
5. Double check that doctors are wiping the surgical area with alcohol-based wipe to guarantee no bacteria is present in that location.

 

Here are ways to prevent a post-surgery SSI:

1. Prohibit friends and family from prodding the new wound.
2. Consult your doctor on how to take care of your wound.
3. Prevent yourself from touching the wound if not necessary.
4. Ensure that friends and family sanitize their hands before entering the vicinity.

 

How do hospitals improve the processes of care known to impact SSI rates?

According to “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals” by Anderson et al, there are three methods to warrant hospitals are on the path to improving care for SSI. The three methods are: Engage, educate and execute.

1. Engage: In this initial stage, we must prioritize the communication methods to highlight the importance of SSI care for patients. If executive level professionals, hospital president, and chief executive officer are able to support the decline of SSI rate, then this all hands-on-deck approach will be effective. It is imperative to include ‘champions’, which means medical staff highly trained in SSI prevention. Lastly, an integrative team that can focus on reducing SSI before and after an operation will ensure the smooth flow of SSI treatment
2. Educate: This stage focuses on educating medical professionals on the cause and effect of SSI. Professionals were provided a 1-on-1 study showing a simulated case of where SSI preventative measures were not adhered to and the negative result of the patient is shown. They must then tackle the case and propose hypothetical solutions to resolve the SSI. Two most important groups that should be educated are c-suite executives and the surgical teams at the hospital. Having the knowledge to correctly operate an SSI or prevent an SSI will help bring it to life in medical practice.
3. Execute: The final stage addresses implementation methodology. There are specific programs designed to reduce SSI rates at hospitals, such as Lean Six Sigma or the Comprehensive Unit-Based Safety Program. Use Information Technology for electronic surveillance, obtaining medical records and information delivery to family members and between hospital staff. Finally, establish a protocol where preoperative and postoperative procedures have SSI risk reduction embedded in them.

Takeaways:

SSI can take place due to surgeries and can be avoided proactively or through adequate aftercare. SSI can be hazardous to health depending on the severity of the infection and should be seen to by a physician immediately. SSI can be treated through antibiotics or minor surgery. Two most important methods to prevent SSI are by letting your doctor know about any prior health conditions that you may have and double-checking sanitation guidelines at the hospital. This will prevent SSI and ensure a healthy and safe post-care for surgery.

 

 

References

 

• Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, L., Nyquist, A.-C., Saiman, L., Yokoe, D. S., Maragakis, L. L., & Kaye, K. S. (2014). Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update. Infection Control and Hospital Epidemiology, 35(6), 605–627. https://doi.org/10.1086/676022
•   Best Practice Recommendations for the Prevention and Management of Open Surgical Wounds. Orsted Heather L., Keast David H., Kuhnke Janet, Armstrong Pamela et al. 1, s.l. :Wound Care Canada, 2010, Vol. 8.
• Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. Patient Safety Network. (n.d.). Retrieved November 2, 2021, from https://psnet.ahrq.gov/issue/centers-disease-control-and-prevention-guideline-prevention-surgical-site-infection-2017.
• Centers for Disease Control and Prevention. (2010, November 24). Surgical site infection (SSI). Centers for Disease Control and Prevention. Retrieved November 2, 2021, from https://www.cdc.gov/hai/ssi/ssi.html.
• K;, O. C. D. S. (n.d.). Surgical site infections: Epidemiology, Microbiology and Prevention. The Journal of hospital infection. Retrieved November 2, 2021, from https://pubmed.ncbi.nlm.nih.gov/19022115/.
• Surgical site infections. Johns Hopkins Medicine. (n.d.). Retrieved November 2, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections#:~:text=Most%20SSIs%20can%20be%20created,caregivers%20wash%20their%20 hands%2C%20too.
• Surgical site infections. Johns Hopkins Medicine. (n.d.). Retrieved November 2, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections.
• Surgical site infections. Patient Safety Network. (n.d.). Retrieved November 2, 2021, from https://psnet.ahrq.gov/primer/surgical-site-infections.
• Thehealthline.ca. (n.d.). Waterloo Wellington Integrated Wound Care Program. woundcare.ca. Retrieved November 2, 2021, from https://wwwoundcare.ca/155/Identify_and_Treat_the_Cause_41_Assessment_of_Surgical_Site_Infections/.
• Thehealthline.ca. (n.d.). Waterloo Wellington Integrated Wound Care Program. woundcare.ca. Retrieved November 2, 2021, from https://wwwoundcare.ca/155/Identify_and_Treat_the_Cause_41_Assessment_of_Surgical_Site_Infections/.
• U.S. National Library of Medicine. (n.d.). Surgical wound infection – treatment: Medlineplus medical encyclopedia. MedlinePlus. Retrieved November 2, 2021, from https://medlineplus.gov/ency/article/007645.htm.