SURGICAL SITE INFECTION

DEFINITION
Surgical site infection is an infection that occurs after surgery in the part of
the body where the surgery took place.

SSI typically occurs within 30 days after

surgery.

If implant 90 Days
 (CDC describes 3 types of surgical site infections )

CATEGORIZED BASED ON DEPTH OF INFECTION

 Risk Classification for SSI:
 CLASS I/CLEAN WOUNDS
an uninfected surgical wound in
which no inflammation is
encountered and the
respiratory, alimentary, genital,
or uninfected urinary tracts are
not entered.
 CLASS II/CLEAN-CONTAMINATED
WOUNDS— a surgical wound in
which the respiratory, alimentary,
genital, or urinary tracts are
entered under controlled
conditions and without unusual
contamination.
 CLASS III/CONTAMINATED
WOUNDS--open, fresh, accidental wounds.
In addition, surgical procedures in which a major
break in sterile technique occurs (eg, open
cardiac massage) or there is gross spillage
from the gastrointestinal tract and incisions
in which acute, nonpurulent inflammation is
encountered are included in this category.
 Class IV/Dirty-Infected
Old traumatic wounds with retained
devitalized tissue and those that
involve existing clinical infection or
perforated viscera.
This definition suggests that the organisms
causing postoperative infection were
present in the operative field before the
operation.
 Pathogenesis of SSI

Endogenous
Patient Flora.
•Skin.
•GI tract.
•Mucous membranes
•Seeding from pre-existing sites of infection .

Exogenous
• Surgical personnel flora .
• Breaks in aseptic techniques .
• Inadequate hand hygiene.
• Contaminated garments.
• Equipment, surgical tools, materials within operative field .
• OR environment, including ventilation .
Source of infecting pathogen .
I use this slide to describe the factors associated for antimicrobial use in the
hospital (immunosuppression, acuity of illness, devices, hospital staff, etc) and that
we as clinicians tend to prescribe for the individual patient and lose sight of our
influence on the ecology of the microbes of the community
 SSI Pathogens

 Staphylococcus aureus - 30.0%

 Coagulase-negative staphylococci - 13.7%
 Enterococcus spp - 11.2%
 Escherichia coli - 9.6%
 Pseudomonas aeruginosa - 5.6%
 Enterobacter spp - 4.2%
 Klebsiella pneumonia - 3.0%
 Candida spp - 2.0%
 Klebsiella oxytoca - 0.7%
 Acinetobacter baumannii - 0.6%
 Strategies 3 levels

Pre-operative

Intraoperative

postoperative
PRE-OPERATIVE STRATEGIES

 PRE-OPERATIVE SKIN PREPARATION.

 PREOPERATIVE SHOWERING.

 SKIN ANTISEPSIS.

 USE OF CLIPPERS FOR HAIR REMOVAL.

 PRE-OPERATIVE GLUCOSE CONTROL.

 INTRAOPERATIVE STRATEGIES
 VENTILATION

POSITIVE PRESSURE VENTILATION.

MAINTAINING A MINIMUM OF 15 AIR CHANGES, 3 FRESH AIR
MINIMIZE TRAFFIC DURING SURGERY.

 CLEANING AND DISINFECTION OF ENVIRONMENTAL SURFACES.

 MICROBIOLOGIC SAMPLING.

 STERILIZATION OF SURGICAL INSTRUMENTS.

 SURGICAL ATTIRE AND DRAPES.

 ASEPSIS AND SURGICAL TECHNIQUE.

 Post operative strategies
Maintain immediate postoperative normothermia

Surgical Wound Dressing

•Protect primary closure incisions with sterile dressing for 24-48 hours post-op.

•Control blood glucose level during the immediate post-operative period .

•Maintain post-op blood glucose level at <180 mg/dL

 Identifying SSI

• Evaluate both clinical and microbiologic findings post-op

•Can’t rely on wound cultures alone to find SSI (!)

• Evaluate surgical patients during hospital stay

•Rounds on units .

•Pharmacy reports of antimicrobial use

•Temperature charts / logs

•Operating room schedule of surgeries/ re-operations

• Monitor surgical patients for re-admission

• Perform post-discharge surveillance

THANK YOU