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Surgical Site infections
1.
2. Surgical Site Infection
Dr. Hany Lotfy MD
Assistant professor of medical microbiology and
Immunology
Sulaiman Al Rajhi Colleges
2015
3. Surgical Site Infections (SSI)
Second most common nosocomial infection (17%).
Most common nosocomial infection among surgical
patients (38%).
2/3 incisional.
1/3 organs or spaces accessed during surgery.
About 300,000 SSIs occur each year.
Prolong hospital stay by 7.4 days.
4. Definition
A surgical site infection (SSI) is an infection that
occurs after surgery in the part of the body
where the surgery took place.
5. Colonization vs Contamination..
Definitions
Colonization:
Bacteria present in a wound with no signs or symptoms of
systemic inflammation.
Usually less than 105 cfu/mL.
Contamination:
Transient exposure of a wound to bacteria.
Varying concentrations of bacteria possible.
Time of exposure suggested to be < 6 hours.
SSI prophylaxis best strategy.
6. SSI – Definitions
Infection:
Systemic and local signs of inflammation.
Bacterial counts ≥ 105 CFU/mL.
7. 1. Superficial Incisional SSI
Infection occurs within 30
days after the operation
and involves only skin or
subcutaneous tissue
of the incision.
Subcutaneous
tissue
Skin
Superficial
incisional SSI
8. 2. Deep Incisional SSI
Infection occurs within 30
days after the operation if no
implant is left in place or
within 1 year if implant is in
place.
The infection appears to be
related to the operation and
the infection involves the
deep soft tissue (e.g., fascia
and muscle layers).
Deep soft tissue
(fascia & muscle)
Deep incisional
SSI
Superficial
incisional SSI
9. 3. Organ/Space SSI
Infection occurs within 30 days
after the operation if no implant
is left in place or within 1 year if
implant is in place and the
infection appears to be related to
the operation.
Infection involves any part other
than the incision, which was
opened or manipulated during
the operation
Deep incisional
SSI
Superficial
incisional SSI
Organ/space SSIOrgan/space
10. Sources of SSI Pathogens
1. Endogenous flora of the patient.
2. Operating theater environment.
3. Hospital personnel.
4. Seeding of the operative site from distant focus of
infection (prosthetic device, implants).
11. Classification and Rates of SSI
Class Type Description %
I Clean An uninfected operative wound without
inflammation.
No intrinsic bacterial flora
8 %
II Clean /
contaminated
Operative wounds in which the respiratory, alimentary,
genital, or urinary tracts are entered under controlled
conditions and without unusual contamination.
Operations involving the biliary tract, appendix,
vagina, and oropharynx
22%
III Contaminated Open, fresh, accidental wounds.
Involves spillage of viscus content.
30%
IV Dirty Old traumatic wounds with retained devitalized tissue
and those that involve existing clinical infection or
perforated viscera.
40%
22. 1. Clinical picture
The typical features of wound infections:
Increased exudate.
Increased swelling.
Increased erythema.
Increased pain.
Increased local temperature.
Peri-wound cellulitis, change in appearance of granulation tissue
(discoloration, prone to bleed, highly friable).
The failure of the wound to heal and progressive deterioration of
the wound.
25. Sample:
Pus or exudates from infected wounds is usually sampled by
swabbing deep in the wound, which must be soaked well in the
exudates.
A specimen of the pus itself is always preferred and can be
obtained by using a syringe and transfer to a sterile tube or
screw capped bottles.
Pieces of tissues removed at operation are sent to the
laboratory for bacterial examination, these tissues are
homogenized in a tissue grinder with a little broth.
Specimen Collection:
26. The gold standard collection method is to do a
tissue biopsy or needle aspirate of the leading
edge of the wound after debridement.
27. If a tissue biopsy is not possible????
Cleanse the wound with sterile saline
Vigorously swab the base of the lesion
Surface wounds place the swab in a sterile
container for transport.
Deep wounds place the swab in a sterile anaerobic
container for transport.
