1. Surgical Site Infections Muhammad Ghous Roll # 105 Batch D Final Year

2. Introduction Any surgery that causes a break in the skin can lead to a postoperative infection. These infections are called surgical site infections.

3. Introduction It is one of the most important healthcare-associated infections. The chances of developing SSI after surgery are 1-3% SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related to it. SSIs can range from a relatively trivial wound discharge with no other complications to a life- threatening condition.

4. Types Surgical site infections are of three types: Superficial Incisional SSI Involves skin and subcutaneous tissue. Deep Incisional SSI Involves deep soft tissue i.e muscles & fascia. Organ or space SSI Involves any area of the body such as body organ or space between organs.

6. Types A superficial incisional SSI may produce pus, called "purulent discharge," from the wound site. Samples of the pus may be grown in a culture to find out the types of microbes that are causing the infection. A deep incisional SSI may also produce pus. The wound site may reopen on its own, or a surgeon may reopen the wound and find purulent discharge inside the wound.

7. Types An organ or space SSI may show a discharge of pus coming from a drain placed through the skin into a body space or organ. An abscess may be seen when the surgeon reopens the wound or by special X-ray studies.

8. Further Classification Early Infection develops within 30 days of surgery Intermediate Infection develops within 1-3 months Late Infection develops after 3 months

9. Further Classification Minor Surgical Site Infection May discharge pus. No excessive discomfort or systemic signs. No delay in returning home.

10. Further Classification Major Surgical Site Infection Discharge significant quantity of pus, systemic signs like pyrexia and tachycardia are present and delayed return to home.

11. Causes Surgical site infections are most commonly caused by bacteria Staphylococcus Streptococcus Pseudomonas E.coli

12. Risk Factors Surgery that lasts more than two hours Being an elderly adult Being overweight Having a weakened immune system Having diabetes Having emergency surgery Having open abdominal surgery

13. Treatment Major surgical infections with systemic signs, cellulitis or bacteremia need treatment with appropriate antibiotic. Tissue or pus culture should be taken before antibiotic cover is started. Choice of antibiotics is empirical until sensitivities are available. If wound is under tension or there is suppuration, sutures or clips need to be removed to allow pus to drain and delayed secondary closure when wound is clean and granulating.

14. Prevention Staff should wash hands before next patient Length of patient stay should be kept minimum Antiseptic skin preparations should always be used and standardized Prophylactic antibiotic therapy before surgery

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