This document discusses surgical site infections (SSI). It defines SSI as an infection occurring within 30 days of a surgical procedure (or up to 90 days if an implant is involved). SSI risk varies by procedure type but is as high as 10% for colon surgery. Clean wounds have a 4% SSI risk while contaminated wounds have a 35% risk. SSI diagnosis involves examining wounds for signs of infection like fever, drainage or pain and confirming with tests like culture. Treatment involves wound exploration, debridement and antibiotics.

1. 7. Surgical Site Infections - SSI
Dr. Ismail M. Hersi
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2. INTRODUCTION
• Surgical site infection (SSI) is the most
common health care–associated infection
following surgery and is associated with
significant morbidity and mortality, transfer to
an intensive care unit setting, prolonged
hospitalizations, and hospital readmission.
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3. DEFINITION
• The United States Centers for Disease Control
and Prevention (CDC) defines an SSI as an
infection related to a surgical procedure that
occurs near the surgical site within 30 days
following surgery (or up to 90 days following
surgery where an implant is involved).
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4. Types
1. Incisional SSIs:
Incisional SSIs are further divided into those
involving only skin and subcutaneous tissues
(superficial incisional SSI) and those involving
deeper soft tissues of the incision (deep
incisional SSI)
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5. ….
2. Organ/space infections:
These include abscess, anastomotic leak for
intra-abdominal operations, and implant-
associated infections.
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9. INCIDENCE AND RISK FACTORS
• The most common reason for unplanned
readmission after surgery is SSI.
• The incidence of SSI varies widely, depending
upon the operative site and wound
classification.
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10. INCIDENCE AND RISK FACTORS
• SSIs are associated with increased morbidity
and mortality .
• The risk of SSI for individual procedures varies
widely.
• The highest rates occur after abdominal
surgery, particularly colon surgery, for which
the SSI rate is about 10 percent.
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11. INCIDENCE AND RISK FACTORS
• Other representative rates for various types of
surgery are coronary bypass surgery (3.3 to
3.7 percent), vascular surgery (0.16 to 29
percent) , caesarian delivery (3.4 to 30
percent) joint arthroplasty with a prosthesis
(0.7 to 1.7 percent), and spinal fusion (1.3 to
3.1 percent). Eye surgery is associated with an
extremely low rate of SSI (0.14 percent).
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12. INCIDENCE AND RISK FACTORS
• SSIs following surgeries that use implanted
materials such as joint replacement, hernia
repairs with mesh, and some cardiac surgeries
are much less common but are associated
with profound consequences.
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13. INCIDENCE AND RISK FACTORS
• Many of the patient factors identified as risk
factors for impaired wound healing (eg,
cigarette smoking, older age, vascular
disease, obesity, malnutrition, diabetes,
immunosuppressive therapy) are also risk
factors for SSI.
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14. SURGICAL WOUND CLASSIFICATION
• The degree of contamination of a surgical
wound at the time of the operation is an
important risk factor for infection and can be
classified using the National Healthcare Safety
Network (NHSN) wound class , which is based
upon an adaptation of the American College
of Surgeons surgical wound classification.
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15. Surgical wound classification
• Surgical site infection (SSI) occurs in
approximately 4 percent of clean wounds and
35 percent of grossly contaminated wounds.
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16. 1. Clean Wound
• Clean – An uninfected operative wound in
which no inflammation is encountered and
the respiratory, alimentary, genital, or
uninfected urinary tracts are not entered.
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17. Clean wound………..
• Clean wounds are primarily closed and, if
necessary, drained with closed drainage.
• Operative incisional wounds that follow non-
penetrating (blunt) trauma should be included
in this category if they meet the criteria.
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18. 2. Clean-Contaminated Wound
• Operative wounds in which the respiratory,
alimentary, genital, or urinary tracts are
entered under controlled conditions and
without unusual contamination.
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19. Clean-Contaminated……….
• Specifically, operations involving the biliary
tract, appendix, vagina, and oropharynx are
included in this category, provided no
evidence of infection or major break in
technique is encountered.
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20. 3. Contaminated Wounds
• These involve operating on an internal
organ with a spilling of contents from
the organ into the wound.
• Open, fresh, accidental wounds are also
considered contaminated.
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21. 4. Dirty or Infected Wounds
• Dirty or Infected – Includes old traumatic
wounds with retained devitalized tissue (dead
tissue) and those that involve existing clinical
infection or perforated viscera.
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24. CLINICAL FEATURES of SSI
• When SSI is suspected, the wound should be
examined directly to facilitate visual and
tactile inspection.
• Fever, erythema , warmth, drainage with or
without odor, wound breakdown and
separation (i.e. dehiscence), peri-incisional
erythema, and pain at the incision site.
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25. DIAGNOSIS
• Superficial SSI can be fully evaluated through
direct observation of the wound.
• CBC
• Ultrasound
• culture
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26. Management
• Wound exploration and debridement.
• Antimicrobial therapy.
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27. Any Questions???
Thank you
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