concise presentation about surgical site infection and surgical wound.

1. Surgical site
infection

2. Definition
– Infection related to an operative procedure that occurs at or near the surgical
incision within 30 days of the procedure or within 90 days if prosthetic material
is implanted at surgery.
– Classification
– Superficial
– Deep
– Organ/space

3. Cross Section of Abdominal Wall
Superficial: involving skin and subcutaneous tissue
only
Deep: involving deep soft tissue of incision
including fascia and muscle layers
Organ/space: any part of body deeper than fascia/
muscle layer that was opened or manipulated
during procedure.

4. Superficial surgical site infection
– Clinical features:
– Signs of inflammation:
– I.e. localized peri-incisional:
– pain/tenderness,
– swelling,
– erythema/heat
– Diagnostic criteria:
 Purulent drainage from superficial infection
 Organism identified by culture, performed for diagnosis and treatment
 Incision opened by surgeon or other designated clinician because of concern for
superficial SSI
Presence of at least one clinical feature
AND

5. Deep surgical site infection
– Clinical features
– Fever
– Localized pain/tenderness
– Diagnostic criteria
 Purulent drainage from deep infection
 Deep Incision, that spontaneously dehisces or opened by surgeon (or other designated)
clinician because of concern for deep SSI
-Organism identified by culture, performed for diagnosis and treatment
– Presence of at least one clinical feature
 Evidence of infection involving deep space identified either through gross anatomic/
histopathologic exam or imaging
AND
AND

6. Organ/space infection
– Diagnostic criteria:
– Appropriate clinical feature as per the organ/ space and at least one of
following:
– Purulent drainage from drain placed into organ space
– Organism identified by culture from fluid or tissue in organ space
– Evidence of infection involving deep space identified either through gross
anatomic/ histopathologic exam or imaging

7. Risk factors
 Age
 Obesity
 Diabetes
 Malnutrition
 Prolonged pre-operative
stay
 Recent operation
 Peripheral vascular
disease
 Skin carriage of S. aureus
 Immunosuppressive
therapy
Contaminated medications
Inadequate disinfection/sterilization
Inadequate skin antisepsis
Inadequate ventilation
Drains
Emergency procedures
Hypothermia
Inadequate antibiotics prophylaxis
Prolonged operative time
Minimally invasive vs open surgery

8. Surgical Attire
– Scrub suits
– Cap/hoods
– Shoe covers
– Masks
– Gloves
– Gowns

9. Surgical Technique
– Removing devitalized tissue
– Maintaining effective hemostasis
– Gently handling tissues
– Eradicating dead space
– Avoiding inadvertent entries into a viscus
– Using drains and suture material
appropriately

10. Class I Wound (Clean)
– Atraumatic wound
without inflammation
– Do not enter GI, GU,
biliary, or respiratory
tract
– 1.5% infection rate
– One example would be
an inguinal hernia
repair.

11. Class II Wound
(Clean-Contaminated)
– Respiratory, GI, GU, or
biliary tract entered under
controlled conditions
– 7.5% infection rate
expected
– Examples would be
cholecystectomy and
elective colon resections

12. Class III Wounds
(Contaminated)
– Traumatic wounds
– Breaks in sterile
technique
– Gross spillage from GI
tract
– Acute, nonpurulent
inflammation
– 15% anticipated
infection rate
– Eg- nonperforated acute
appendicitis.

13. Class IV Wounds (Dirty)
– Old traumatic wounds
– Devitalized tissue
– Clinical infection
present
– Perforated viscus
– 40% expected
infection rate