Surgical site infection Based on open who

2. Surgical site infections (SSI) refer to infections that
occur after surgery in the part of the body where
surgery was performed.
SSI can sometimes be superficial, involving the
skin only. Other SSI are more serious, and can
involve tissues under the skin (for example, muscle
layers), organs, or implanted material.

4. Date of event for infection occurs within 30 days
after the surgical procedure (where day 1 = the
procedure date)
and
involves only the skin and subcutaneous tissue of
the incision

5.  And
 patient has at least one of the following:
 Purulent drainage from the superficial incision.
 Organisms identified from an aseptically-obtained specimen
from the superficial incision or subcutaneous tissue by a
culture or non-culture-based microbiologic testing method
which is performed for the purpose of clinical diagnosis or
treatment.
 Superficial incision that is deliberately opened by a surgeon,
attending physician, or other designee and culture or non-
culture based testing is not performed.

6. And
patient has at least one of the following signs or
symptoms: pain or tenderness, localized swelling,
erythema, or heat.
Diagnosis of a superficial incisional SSI by the
surgeon, attending physician, or other designee.

7. The date of event for infection occurs within 30 or
90 days after the surgical procedure (where day 1 =
the procedure date) according to Surveillance
Periods for SSI Following Selected NHSN
Operative Procedure Categories
and
involves deep soft tissues of the incision (for
example, fascial and muscle layers)

8. And
patient has at least one of the following:
Purulent drainage from the deep incision.
A deep incision that spontaneously dehisces; or is
deliberately opened or aspirated by a surgeon,
attending physician, or other designee;

9. And the organism is identified by a culture or non-
culture based microbiologic testing method which
is performed for purposes of clinical diagnosis or
treatment or culture or non-culture based
microbiologic testing method is not performed;
and patient has at least one of the following
symptoms: fever (> 38º C); localized pain or
tenderness. A culture or non-culture based test
that has a negative finding does not meet this
criterion.

10. An abscess or other evidence of infection involving
the deep incision that is detected on gross
anatomical or histopathologic exam or imaging
test.

11. Date of event for infection occurs within 30 or 90
days after the surgical procedure (where day 1 =
the procedure date) according to Specific Sites of an
Organ/Space SSI
and
infection involves any part of the body deeper than
the fascial/muscle layers that is opened or
manipulated during the operative procedure

12.  And
 patient has at least one of the following:
 Purulent drainage from a drain that is placed into the organ/space (for
example, closed suction drainage system, open drain, T-tube drain, CT
guided drainage).
 Organisms are identified from fluid or tissue in the organ/space by a
culture or non-culture based microbiologic testing method which is
performed for purposes of clinical diagnosis or treatment.
 An abscess or other evidence of infection involving the organ/space that is
detected on gross anatomical or histopathologic exam, or imaging test
evidence suggestive of infection.

13. And
meets at least one criterion for a specific
organ/space infection site (Specific Sites of an
Organ/Space SSI).

15. Clean wounds are uninfected operative wounds in
which no inflammation is encountered, and the
respiratory, alimentary, genital, or uninfected
urinary tracts are not entered.
In addition, 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.

16. Clean-contaminated wounds are operative wounds
in which the respiratory, alimentary, genital, or
urinary tracts are entered under controlled
conditions and without unusual contamination.
 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.

17. Contaminated wounds are open, fresh, accidental
wounds.
In addition, operations with major breaks in sterile
technique (for example, open cardiac massage) or
gross spillage from the gastrointestinal tract, and
incisions in which acute, non-purulent
inflammation is encountered including necrotic
tissue without evidence of purulent drainage (for
example, dry gangrene) are included in this
category.

18. Dirty or infected wounds include old traumatic
wounds with retained devitalized tissue, and those
that involve existing clinical infection or perforated
viscera.
This definition suggests that the organisms
causing postoperative infection were present in the
operative field before the operation.

20.  Advanced age
 Diabetes
 Obesity
 Smoking
 Immunosuppressive drugs (corticosteroids)
 Staphylococcus aureus (bacteria) carriage (nasal or other)
 Distant infection focus (e.g., presence of urinary tract
infection before neurosurgery)
 Malnutrition

21. Preoperative length of stay
Appropriate surgical antibiotic prophylaxis
Hair removal at the surgical incision site

22. Wound classification
Operative technique, degree of tissue trauma
Prolonged duration of surgery
Traffic intensity in the operating room
Presence of foreign body
Need for blood transfusion

23. The sources of pathogens are both the patients
themselves and external sources:
endogenous flora: the patient’s skin, mucous
membranes, and hollow viscera
exogenous organisms: air in the operating room;
the surfaces of surgical equipment, implants, and
gloves/hands; and medications administered
during operative procedures

24. For example:
Endogenous infections: Patient’s own microflora
(e.g., S. Aureus from nasal carriage)
Staff in the operating room: Staphylococci from
nasal carriage, skin on hand, and forearm via
contact with punctured gloves or wet gown
Environmental source: Contaminated air and dust
due to inadequate ventilation and cleaning