SURGICAL SITE INFECTIONS

NEGINE PAUL
Assistant Professor
Dept. of General and Upper GI Surgery
17.9.2019
 As we go through…
• Definition of SSI
• Epidemiology
• Classification of SSI
• Classification of Surgical wounds
• Risk factors for SSI
• Resources
 Surgical site infection (SSI)
• Surgical site infection (SSI) is a type of
healthcare-associated infection in which a
wound infection occurs after an invasive
(surgical) procedure
 Definition SSI
• Infection occurring within 30 days of the
operation or within 1 year if an implant is left
in place (eg: heart valve, vascular graft,
prosthetic joint, mesh)

CDC – Centre for disease control

 SSI - Epidemiology
• 3rd most common nosocomial infection:14-
16%
• Most common nosocomial infection in surgical
patients: 38%
• About 5% surgical patients develop an SSI
• 2-5% after extra-abdo & 10-20% abdominal Sx
• Worsened QOL, increase pain and suffering,
extended hospital stay, morbidity & mortality
and increased cost
Classification of surgical wounds

Berard F, Gandon J, Ann Surg 1964

 Classification of SSI
• Incisional
- Superficial (skin/subcutaneous)
- Deep (soft tissue/muscle)
• Organ space
• Caused by:
- Endogenous bacteria – patients’ own skin flora
- Exogenous bacteria – environmental bacteria
or surgical material
CDC – Centre for Disease Control
SSI classified…
 Superficial Incisional SSI
• Skin and subcutaneous tissue
• Meets one of the following criteria:
- purulent drainage
- organisms cultured from fluid or tissue
- displays at least 1 of the: pain, edema, redness,
and incision is opened by surgeon
- diagnosis of superficial incision SSI by surgeon
 Deep Incisional SSI
• Deep soft tissue ( fascial and muscle layers)
• Meets at least one of the following criteria:
- purulent drainage
- spontaneously dehisces or opened by the
surgeon and the patient has at least one
of the following: fever, pain, abscess
- diagnosis by surgeon
 Organ Space SSI
• Infection involves any part of the anatomy (organs or spaces), other
than the incision, which was opened or manipulated during an
operation
and at least one of the following:
- purulent discharge from drain placed into the organ/ space

- organisms isolated from an aseptically obtained culture

- an abscess or other evidence of infection involving the organ/

space that is found on direct examination, during reoperation, or
by histopathologic or radiologic examination

- diagnosis of an organ/ space SSI by surgeon or attending physician

 Risk factors for SSI
• Patient specific
- Local
- Systemic
• Surgical
 Patient specific factors
 Local:  Systemic:
 High bacterial load  Advanced age
 Shock
 Wound hematoma
 Diabetes
 Necrotic tissue
 Malnutrition
 Foreign body
 Alcoholism
 Obesity
 Steroids
 Chemotherapy
 Immuno-compromise
 Surgical factors
• Type of procedure: alimentary > non-alimentary
• Degree of contamination: feces, pus
• Duration of operation: longer > shorter
• Blood loss: >1-1.5 L
• Intra-op temperature: hypothermia > normothermia
• Urgency of operation: emergency > elective
• Skin preparation: type of solution, no. of coating and timing
• Operating room environment: traffic, air control

• Antibiotic prophylaxis: drug, dose, route, timing of

administration, repeat doses
 Best way to prevent HAI
“Soap, water & common sense are the best
disinfectants”
When to wash/ clean hands???
“5 moments of hand hygiene”
Wash your hands from today…
 References/ Resources
• CDC guidelines for prevention of SSI
• NICE guidelines for prevention of SSI
• WHO guidelines for prevention of SSI
• IDSA guidelines for prevention of SSI
• RCSI guidelines for prevention of SSI

• CMC protocol for antimicrobial therapy