2. • Definition:Surgical site Infection is the infection that occurs after the
surgery in the part of the body where the surgery took place.
• Center of disease control classification
• 1) Superficial incisional
• 2)Deep incisional
• 3)Organ/Space surgical site infection.
9. 1)Patient related factors
• -Nutritional status
• -Immunologic status
• -Infection at a remote site
• 2) Surgeon dependent
• -Operating environment
• -Surgical technique
• -Prophylactic antibiotics
• -Skin and wound care
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10. Patient dependent
• 1) Nutritional
• -Malnutrition affects humoral and cell mediated immunity,impairs neutrophil
chemotaxis, diminishes bacterial clearance and decreases neutrophil bactericidal
function.
• 2) Immunological status
• -Bodys response-Neutrophil response,humoral immunity,cell mediated immunity,
reticuloendothelial cells.
• A deficiency in production or function of any of these predisposes to infection
• Diabetes, alcoholism, haematological malignancy, cytotoxic drugs,
Hypogammaglobulinemia with splenectomy can increase risk of surgical site
infection.
11. Surgeon dependent
• 1)Skin preparation
• Proper skin preparation decreases contamination caused by bacteria.
Proper surgical attire-If not worn increased risk of wound infection.
.Gloves not worn properly-Increased risk of wound infection.
12. • 2)Operating room environment
• Airborne bacteria
• If too many people are there there is an increased risk of wound infection.
• 3)Prophylactic antibiotic therapy
• First 6 hours are golden period after which no of bacteria multiply exponentially
• Antibiotic should be given prophylactically 30 mins before skin incision and
repeated every 4 hours intraoperatively or whenever blood loss exceeds 1000 ml.
• If not given increased incidence of wound infection.
17. • 1) Antimicrobial Prophylaxis should be started,choice of the
antimicrobial will depend on the culture and sensitivity report.
Timing of antibiotic prophylaxis-30 minutes before surgical incision
2) Debridement-Remove necrotic and avascular bone,bacteria and
harmful products.
20. Prevention of surgical site infection
• Prior to OT-Adequate control of the diabetes,smoking and alcohol cessation should be done.
• In patients with soiled wounds a thorough cleaning of wounds should be done Prior to Surgery.
• 1)Hand hygiene
• Proper hand washing.
• Double gloving
• Surgical site should be properly scrubbed and draped.
21.
22. 2)Surgical attire-Should be tightly woven,stain resistant and durable.
• Pore size should be less than 80 microns
• Cap and mask should be worn.Caps should cover the entire head
• Fresh disposable masks should be worn for each surgery.Change
disposable masks every 3-4 hours.
• In Ots a frEsh dress should be used for each day
• While wearing dress care should be taken to preven contact with
floors and other contaminated surfaces.
23. • 3)Lamellar air flow
• Air moving at same speed in same direction with no crossing over.
24.
25. • 4)Proper cleaning of the ot prior to fumigation.If an infected case has been
performed in an OT that ot should be sealed and no case should be taken
after that.
• Fumigation of ot
• 5)Screening of personnel inside ot-Those having an upper respiratory tract
infection,skin lesions should be screened and should not be allowed to
enter the ot complex.
• 6) Instruments should be sterilised Prior to use.
• 7)Proper disposal of the biomedical waste
8)While suturing preferably use blunt suture needle,2 surgeons should not
suture same site simultaneously.
26.
27. • 9)Change outer layer of gloves before applying dressing.
• 10)Discard and remove contaminated drapes.
• 11)Remove all contaminated clothing and material and place the
contaminated material in bags and discard.
