General principles in management and prevention of surgical wound infection

1. SURGICAL SITE INFECTION
Presenter: Dr. Moses Cletus
Moderator: Dr. Bashir

2. OUTLINE
o INTRODUCTION
o DEFINITION
o CLASSIFICATION
o TYPES
o SOURCES
o PATHOGENESIS
o CLINICAL PRESENTATION
o INVESTIGATION
o PREVENTION
o MANAGEMENT
o COMPLICATIONS
o CONCLUSION

3. INTRODUCTION
o All surgical wounds are contaminated by bacteria, but
only a minority actually demonstrate clinical infection
o Surgical site infection are not an extinct entity as they
account for 3rd most common hospital infection
o In Nigeria incidence ranges from 14-27% with
highest incidence in north-east( Ahmed et al 2018)
making it a major patient safety concern in hospital
o <1900 – Mortality was about 70-80%

4. Definition
Definition Of Terms:
Contamination- the mere presence of pathogenic microorganism on a surface
Colonization- the replication/proliferation of microorganism
Infection- the host immune response to the invasion of rapidly replicating
microorganism
SIRS- systemic manifestation to the presence of infection(has many variables)
Sepsis- Documented or suspected infection with some of the findings of SIRS.
Has 2 subset( severe sepsis and septic shock)

5. Surgical Site Infection- Are infection of the tissue
,organ or space exposed during performance of an
invasive procedure usually occurring within 30days of
the procedure or 1y if with implants.
It was a revision in 1992 by CDC from wound infection
to prevent confusion

6. Classification
• Base on severity

7. • Base on degree of contamination

8. • Base on duration

9. Types

16. Pathogenesis

17. Sources
Exogenous
Surgeons, nurses and other staffs
Medical equipment
Other patient
Endogenous
Skin flora
Other infection in patients
Blood transfusion

18. Risk factors
 Patient factors
 Microbial factors
 Local factors

19. Patients factors
 age
 obesity
 immunosuppression
 DM
 malnutrition
 smoking
 anemia
 steroids use

20. Microbial factor
 Prolong hospitalization
 Resistance to clearance(capsule formation)
Virulence(toxin secretion)

21. Local factors
 Excessive use of cautery
 Poor skin preparation
 Braided sutures
 Drains/catheters
 Inadequate antibiotic prophylaxis
 Hypoxia
 Hypothermia
 Contaminated instrument

22. Wound scoring system

24. • Score 0-10=satisfactory healing
• 11-20=disturbance of healing
• 20-30=minor wound infection
• 31-40= moderate wound infection
• >41= severe wound infection

25. Risk assessment
• SCENIC SCORE
-abdominal surgery
-operation >2hours
- class iii and iv
->3diagnosis at discharge from hospital
Risk score od 0=1% ,1=3.6%, 2=9%, 3=17% and
4=27% risk of infection

26. Clinical presentation
• Local- pain/tenderness, swelling, warmth, induration,
shiny erythematous skin, purulent discharge
• Systemic-
pyrexia, chills, malaise, increase HR and RR
• Non-specific-
fever, erythema , leucocytosis

27. Investigation
• Diagnosis is clinical, Investigation helps in treatment
and follow up
• MCS, Tissue biopsy
• USS
• FBC+D
• For underlying conditions e.g DM, foreign body,
anastomotic breakdown, fistula formation

28. Prevention
General principles involve maneuvers to
• Diminish presence of exogenous sources
(surgeons, theatre, ward ,other patients)
• Diminish presence of endogenous sources(patient)
antimicrobial, chemically, mechanically etc

30. Management
The precept of mgt differs
-Drainage of all purulent material
-Debridement of all infected, devitalized tissue and
debris
-Removal of foreign bodies at site of infection
-Antimicrobial agents

31. Complications
Depend on site of infection, nature of surgery and underlying host factor
Early
-Necrotizing fasciitis
-Wound dehiscence
-Metastatic abscess
-Septisemia
-Organ failure
Late
-Incisional hernia
-Deforming scar

33. • SSI is a major problem in surgical practice despite
been preventable
• It is the responsibility of all health care provider to
work towards its prevention with a team approach
involving the patient, surgeon and hospital
management team

34. Reference
 Schwartz's principle of surgery chpt6
 E.A Badoe Principles and Practice of surgery 4th ed.
 Bailey and Love 26th ed. Chpter 5
pg 51-57
 Africa Journals Online, S Afr Fam Vol 56 No2, dept
anaesthesia chris hani university of witwatersrand

35. THANK YOU FOR
LISTENING
“As to disease, make a habit of two things-
To help,
Or At least to do no harm”
Hippocrates.