The points in this post have been extracted from a TOG article published in April 2021. Surgical site infection poses a challenge for surgery and has huge impact on patient care/safety and healthcare system. It is an important cause of patient morbidity and if severe can even lead to death.
Different guidelines have been produced to address this issue. This article provides a very good resource of comprehensive information about SSI.
It is recommended to read the original article to grasp the topic completely.
I hope you find this post helpful.
Suggestions to improve future posts are welcome.
Thanks
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Introduction
- SSI remains a peri-surgical problem
- May lead to severe morbidity & mortality, prolonged hospitalisation & enormous economic costs
Measure to reduce SSI
- Improved ventilation in OTs
- Equipment sterilisation
- Barrier use during surgery
Factors which increase SSI
- Antibiotic resistant pathogens, chronic disorders like DM, alcoholism, obesity & immunosuppression
- In obstetrics SSI associated with prolonged labour, emergency CS & multiple vaginal examinations
- Common pathogens include gram +ve & -ve organisms such as Staphylococcus aureus & E. Coli
Definition
- Infection of superficial or deep skin incision, or of an organ or space, occurring up to 30 days after surgery if no implant was left behind, or within 1 year if an implant was left in place
Specific Criteria for diagnosis
Superficial wound infection at least one of the following
- Purulent effluent or exudate with organisms identified
- One of following: pain, redness, localized swelling, tenderness or heat
- Diagnosis by surgeon or attending physician
Deep wound infection at least one of the following
- Purulent exudate from deep wound incision
- Spontaneous dehiscence of deep incisional wound or if deliberately opened with temp >30˚C, localized pain or tenderness
- Abscess or infection involving deep wound incisions
- Diagnosis by surgeon or attending physician
Organ or space infection at least one of the following
- Purulent exudate from a drain
- Organism isolated
- Evidence of abscess or infection
- Diagnosis by surgeon or attending physician
Wound Classification
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| Ref: TOG |
Epidemiology
- Incidence 2-6% of surgeries in high-income countries
- UK in 2006 survey
- Incidence of health care-acquired infection 8% out of which 14% were SSI
- 5% patients having surgery had SSI
- Incidence varies according to the type of surgery
- Highest after bowel surgery 8%
- Lowest after knee replacement 0.5%
- After TAH 1.6%
- After CS 3-15%
Risk factors
