SURGICAL SITE INFECTION AND ITS PREVENTION

ORTHOPAEDICS

1. SURGICAL SITE INFECTION Dr.Sunil kr Chaudhary 1 st Year Resident

2. SSI is major problem in surgical practice In 1992 ,the US Centers for Disease Control (CDC) revised its definition of ‘wound infection ‘, creating the definition ‘Surgical Site Infection’ (SSI) to prevent confusion between the infection of a surgical incision and infection of a traumatic wound Its accounts for 15-25% of all surgical infections .

3. Definition – The infection of a wound can be defined as the invasion of organisms through tissues following a breakdown of local and systemic host defences Leading to local and systemic presentation SSI includes de novo infectious diseases that require surgery or procedural interventions for cure Duration within 30 days of surgery and 1 year for mesh or prosthesis implant .

4. Micro-organisms-

5. Important Definitions- SSI infected incised wound or deep organ space SIRS body systemic response to an infected wound MODS the effect that the infection produces systemically MSOF the end stage of uncontrolled MODS.

6. SIRS ( Systemic Inflammatory Response Syndrome ) Any 2 Hyperthermia (>38 degree ) or Hypothermia <36 Tachycardia >90/min Tachypnoea >20/min WBC > 12000/ ccmm or <4000/ ccmm

7. Sepsis –SIRS with documented infection Sepsis syndrome- sepsis with evidence of one or more organ failures

8. pathogenesis

9. Risk factors for SSI Malnutrition –obesity Metabolic disease-DM/Jaundice Immunosuppression conditions Colonisation of GIT Poor perfusion –Shock Foreign body Poor surgical technique

10. Factor –Determine Host response Virulence Vasculature and health of tissue Presence of dead /foreign tissues

11. SSI assessment For surgical wound assessment several scoring systems are employed Asepsis wound score Southampton wound grading system These enable surgical wound healing to be graded according to specific criteria ,usually giving a numerical value , thus providing more objective assessment of wound.

12. Types of SSI Superficial incisional SSI Occurs within 30 days Skin and subcutaneous tissue Purulent discharge +/- 1 sign of inflammation Incision –opened and diagnosed by surgeon

13. Deep incisional SSI Occurs -30 days – 1 year of the operation Deep soft tissue Purulent discharge – not from organ Spontaneously opened or deliberately opened Deep abscess –confirm by re-operation Opened and diagnosed by surgeon

14. Organ /space SSI Occurs 30days – 1 year Involves any part (organ /space ) Purulent discharge – drainage Organism –isolated Deep abscess –direct /re-operation /histology/X-ray Opened and diagnosed by surgeon

15. Classification of surgical wounds

16. Pre-operative measures Provide SSI prevention education to patient or caregiver Reduce HbA1c level Provide weight loss , diet modification and smoking cessation Provide preoperative bathing instructions Perform decolonisation of patients who are nasal carriers of staphylococcus aureus Use clippers for hair removal

17. Operative Theatre Ensure –sterile caps , masks ,gown and gloves Skin cleaning – povidone iodine Drapes – dry and instruments – sterilised Avoid – unimpregnated plastic drapes Administer antimicrobial prophylaxis 1 hour before surgery Optimise tissue oxygenation using supplemental oxygen Laminar airflow and filters Maintain normothermia Gentle tissue handling /absolute homeostasis and appropriate suture materials

18. Post-operative measures Discontinue antimicrobial agents within 24 hours after procedure Maintain the patients postoperative glucose level , normothermia and tissue oxygenation using supplemental oxygen Perform thorough hand hygiene and use sterile supplies for dressing Provide discharge instructions for SSI prevention to patient and caregiver

19. Treatment of SSI Management depends on type of SSI Surgical debridement of the wound Suture removed –free drainage Fluid –C/S –suitable antibiotics Signs of healing – secondary suturing Removal of implants

20. References Bailey and love SRB manual of surgery

21. THANK YOU