Infection preventionists working in healthcare settings strive to mitigate patient’s exposure to various pathogens, especially in surgical procedures. Among the most prevalent postoperative complications constitutes surgical site infections (SSIs). These infections are a subset of healthcare-associated infections (HAIs) and account for approximately 20% of all HAIs globally. SSIs are identified by three crucial characteristics. They must occur within 30 days post-surgery, involve only specific body tissues – skin, subcutaneous tissues, deep tissue, or distant organs and holds a definite presentation of purulent discharge or isolated organisms around the wound site.
Microbiological threats causing SSIs are often introduced to the surgical site preoperatively, intraoperatively, or postoperatively. Predominantly, these organisms are endogenous to the human body and include pathogens such as Staphylococcus aureus, Escherichia coli, and coagulase-negative staphylococci. Immediately a skin incision is made, there’s a raised risk of an endogenous microorganism contaminating the wound. Also, exogenous organisms, like microbes on surgical instruments, or from the surgical team, can access the surgical wound, hence the need for maintaining sterility throughout a procedure.
Several patient and procedural factors can elevate SSIs risk. In the case of patients, their sex, weight, age, and comorbidities weigh into this equation. For instance, a study patterned that men face higher infection risks than their women counterparts. Procedural risks are biased and are dependent on different factors; these include the operation type, duration, skin preparation, and perioperative length of stay. The findings of a Greece-based study indicated a higher tendency of SSIs occurrence in lengthy surgical procedures, surpassing 90 minutes.
Recognizing SSIs is crucial to timely treatment decisions. They are typically marked by common systemic signs of infection such as fever, chills, altered mental status, increased heart rate; but may also manifest as pain, skin redness, swelling, presence of pus at the surgical site. A persistent condition known as wound dehiscence suggests a possible infection and healthcare staff should stay on high alert for this sign, which normally occurs about 5-10 days post-surgery.
To ascertain the presence of an infection, a microbiology sample which tests for the infecting organism and subsequently suggesting treatment dependencies is necessary. Sampling must be done aseptically using sterile cotton swabs and the sample should be immediately processed in a microbiology lab within 30 minutes. In cases where sample processing must be delayed, refrigeration is recommended.
Upon suspicion of a deep infection, healthcare professionals could resort to the use of ultrasound, computed tomography, or magnetic resonance imaging for further evaluation. Moreover, prescribing antibiotics at the start of infection progression is highly advisable.
SSIs prevention is invaluable. Applicable measures entail prophylactic antibiotics use, cleanliness maintenance, consistent sterility throughout surgeries, and patient education on risk factors such as weight, diabetes, and smoking habits, which may potentially increase their SSIs chances.
Furthermore, post-operative wound dressings should be prioritized, remaining on the incision for not less than 48 hours post-surgery. Also, patients should steer clear of wetting the dressing and wound site within this period. If the need to replace the dressing arises, an aseptic technique should be applied, and the patient should avoid directly touching the incision.
SSIs bear fatal implications for patients, contributing to more than one-thirds of postoperative deaths, as well as increased hospitalization stays, costs, and higher morbidity and mortality rates. Statistics indicate a medium length of stay for patients with SSIs of about 11 days, with associated mortality rates of about 3%.
Safeguarding against SSIs remains a critical concern for infection prevention specialists, with the recognition and prompt management of SSIs ensuring a reduction in patient fatalities and disease spread.