SURGICAL SITE INFECTION (SSI). PPT .pdf

This presentation provides an in-depth overview of surgical site infections (SSI), including their causes, risk factors, and preventive measures. It covers best practices in infection control, effective management strategies, and the latest guidelines for healthcare professionals to minimize SSIs. Ideal for healthcare students and professionals seeking to enhance patient care quality and safety in surgical settings.

1. MS.SHANMUGAPRIYA.K
MSC NURSING 1
ST
YEAR
DEPT, OF MEDICAL SURGICAL NU RSING
GANGA COLLEGE OF NURSING
COIMBATORE-22

2. SURGICAL SITE INFECTION &
PREVENTION

3. WHY THIS TOPIC?
SSI is MOST COMMON hospital acquired infection in
surgical patients.
3rd most common hai.
Preventable.
Long the hospital stay (7.3 days).
Expenditure.
Over one-third of postoperative deaths.

4. Asurgicalsiteinfections
Isanininfectionthat
Occursaftersurgeryinthe
Partofthebodywherethe
Surgerytookplace.

5. •Surgical site infections have
been shown to compose up
to 20% of all health care-
associated
infections.Atleast5% of
patients undergoing a
surgical procedure develop
a surgical site infection.
•It is a 3rd most HAI.

6. •SUPERFICIAL
INCISIONAL SSI
•DEEP INCISIONAL SSI
•ORGAN/SPACE SSI

7. SUPERFICIAL INCISIONAL SURGICAL
SITE INFECTIONS
•Infections occur within 30 days of procedure
Involve skin or subcutaneous tissue.
•Patient has atleast 1 of the following:
Purulent drainage from incision with or without lab confirmation
Organisms isolated from aseptically obtained fluid or tissue in
wound
Pain or tenderness, swelling , warmth or redness
Diagnosed as infection by surgeon.

8. DEEP INCISIONAL SSI
•Infection occur with in 30 days of procedure(or one year in
the case of implants.
•Involve deep soft tissues ,such as the fascia and muscles.
•Patient has at least 1 of the following:
•Purulent drainage from deep wound but not involving space or
organ
•Deep incision dehisces or opened by surgeon for fever or collection
unless the culture is negative
•An abscess or any other evidence is found clinically during
reopening or radiologically
•Diagnosis by surgeon

9. ORGAN OR SPACE SSI
•Within 30 days of surgery and if implant is used within 90 days
(one year previously)
•Infection involves the organ and the space which was
manipulated during surgery
•And involves
•Purulent discharge from drain site, or culture from fluid
•Radiological or direct evidence of abscess
•Diagnosis by the surgeon

10. CLASSIFICATION

11. RISK FACTORS
Risk factors for
Local factor
Developing SSI
Patient factors
Local factor
Microbial factor

13. LOCAL FACTORS
Poor skin preparation
Contamination of instruments
Inadequate antibiotic prophylaxis
Prolonged procedure
Site and complexity of procedure local tissue necrosis
Hypoxia
Hypothermia

14. MICROBIAL FACTORS
Prolonged hospitalization
Toxin secretion
Resistance to clearance
( E.G.,Capsuleformation)

16. PRE-OP FACTORS
•Preoperative antiseptic
showering
•Preoperative hair removal
•Patient skin preparation in
the operating room
•Preoperative hand/forearm
antisepsis (alcohol solution,
chlorhexdine
gluconate,lodophors)
•Antimicrobial prophylaxis

17. ANTIBIOTIC PROPHYLAXIS FOR SURGERY
Type of surgeries Example Preferred choice
Clean surgery Without implants Elective procedures & closed fractures Cefuroxime 1.5gmSingle dose
Clean surgerywith implants TKR, THR, closed fractures
Cefuroxime 1.5gm at induction followed by 2 doses
of 750mg at 8
th
hourly interval
Clean contaminated urgery(operative wound
under controlled conditions without unusual
contamination)
Operations involving the biliary tract, appendix,
vagina
Cefuroxime 1.5gm within 1 hrbefore surgery
followed by 2 days of 8th hrlyCefuroxime 750mg
+Amikacin1gm single dose for 2days+/-
Metronidazole Urological surgery gentamicin
2mg/kg prior to surgery
Oro pharynx, maxillo facial
Co amoxyclav1.2gm 8
th
hrly + Metronidazole
500mg 8
th
hrly for 2 days
Contaminated wounds
Open fresh accidental wounds, non purulent
inflammation & all open injuries including Grade
I, II and III Send specimen for
culture/sensitivity
Cefuroxime1.5gm within 1 hr before sx Followed
by Cefuroxime750mg at 8 hourly
intervals+Amikacin1gm single dose for 2days+/-
Metronidazole
Dirty-infected wounds (Old traumatic wounds
with retained devitalised tissue and those that
involve existing clinical infection or perforated
viscera)
Organisms causing postoperative infection are
present in the operative field before the
operationSend specimen for culture/sensitivity
Cefuroxime1.5gm within 1 hrbefore surgery
followed by 2 days of Cefuroxime750mg at 8
hourly intervals+Amikacin1gm single dose for
2days+/-Metronidazole
Neuro surgery Clean cases
Cefuroxime 1.5gm + additional doses as deemed
necessary
Neuro surgery Entering sinuses / complicated Cefaperazone+ sulbactum1gm IV BD for 2 days

18. EMPIRICAL ANTIBIOTIC THERAPY FOR COMMON INFECTIONS
Infections Etiologies Primary Alternative comments
Post traumatic meningitis
including shunt infections
Staph. AureusGram-ve bacilli Vancomycin 15 mg/kg TDS +
Cefotaxime 2gm IV TDS
Vancomycin 15 mg/kg TDS
+ Meropenam 2gm IV TDS
Consider intra ventricular
injections in A.baumannii
infection
Brain abscess Staph. AureusEnterobacteriaceae Cefotaxime 2gm IV TDS For MRSA Vancomycin +
Cefotaxime
For Pseudo-monas add
Ceftazidime or Meropenam
Osteomyelitis post internal
fixation of fracture
Staph. AureusGram-ve bacilliPseudomonasVancomycin + CeftazidimeLinezolid + LevofloxacinSend specimen for culture
sensitivity before starting
antibiotics
Post spinal implant Staph. AureusGram-ve bacilli Vancomycin + Ceftazidime Linezolid + Cefepime
+tazobactum
Send specimen for culture
sensitivity before antibiotics
Prosthetic joint infectionStaph. AureusGram-ve bacilli Vancomycin + ceftriaxone for
6weeks
Linezolid + levofloxacin for
6 weeks
Surgical debridement and
spacer 1 or 2 stage
Uncomplicated UTI E.coli, Enterococci TMP-SMX DS for 3 days Levofloxacin or Nitro-
furantoin
For ESBL producers
Ertapenam
Complicated UTI (catheter,
obstruction etc.)
E.coli, Pseudomonas, EnterococciLevofloxacin +-Nitrofurantoin Ertapenam Send specimen for culture
sensitivity
Community acquired
pneumonia
St.pneumo and atypicals Azithromycin + CefuroximeErtapenam + Azithro-mycin Add fluro quinolones as an
alternative
Ventilator associated
pneumonia
ESBL, pseudomonas, Acinetobacter Imipenam or Meropenam For Pseudomonas add PIP-
TAZ or Tobramycin
For Acinetobacter add Colistin
+-sulbactum
Secondary peritonitis
following surgery, perforation
Enterobacteriaceae, Pseudomonas,
Enterococci, Bacteroids
Cefuroxime +metronidazoleFor complicated infections
PIP-TAZ or Tigecycline
Peritonitis due to ruptured
bowel, gangrene or abscess
Intra Vascular catheter related
infections
S.aureus, S.epidermidis, MRSA Linezolid or Vancomycin Clindamycin Remove lines and observe
aseptic techniques during
insertion
Necrotizing fasciitis S.aureus, Strept. Sp, Clostridia sp.Penicillin or ClindamycinMeropenam or Imipenam if
poly microbial
Prompt surgical debridement

19. POINT TO REMEMBER
Once the incision is made,
antibiotic delivery to the
wound is impaired .Hence
must given before incision

20. INTRA OPERATIVE FACTORS
•Patient skin preparation
•Incision drapes
•Sterile gown & gloves
•Patient homeostasis
•Theatre discipline
•Wound dressing.

21. POST OPERATIVE FACTORS
•Incision care
The type of postoperative incision care.
Closed primarily :the incision is usually covered with a
sterile dressing for 24 to 48 hours.
Left open to be closed later :the incision is packed with a
sterile dressing.
Left open to heal by second intention: packed with sterile
moist gauze and covered with a sterile dressing.

22. CONT....
•Changing dressing:
•Use an aseptic non-touch technique for changing or removing surgical
wound dressings.
•Postoperative cleansing:
•Use sterile saline for wound cleansing up to 48 hours after surgery.
•Advise patients that may shower safely 48 hours after surgery.
•Use tap water for wound cleansing after 48 hours if surgical wound h
separated or has been surgically opened to drain pus.
•Topical antimicrobial agents for wound healing by primary intention.