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Surgical Site Infections - Coggle Diagram
Surgical Site Infections
Epidemiology
Related to operation
Infection occurs near surgical incision
Within 30 days of procedure
Within 1 year of procedure in implanted prosthetic material
Most common hospital-acquired infection
Risk factors
Patient factors
Obesity
Smoking
Can affect wound healing
Older age
Immunosuppression
Severe underlying disease
Surgical factors
Contaminated surgery
E.g. bowel surgery
Poor technique
Prolonged procedure time
Poor preoperative skin preparation
Causative organisms
Clean surgery (no obvious contamination)
Staph. aureus
(incl. MRSA)
Beta-haemolytic streptococci
Groups A, B, C, F, G
Contaminated surgery (bowel/gynaecological)
May be mixed infection with "clean surgery" organisms + enterobacteriaceae and anaerobes
Prosthetic devices
Multiple potential pathogens
Coagulase - staphylococci
Pathogenesis
Superficial incisional
Skin and subcutaneous tissue
Deep incisional
Muscle and fascia
Depends on surgery performed
Organ space
Organs or deeper spaces other than incisional site
Clinical Manifestations
Cellulitis of wound
Pain
Erythema
Warmth
Swelling of wound
+/- Wound discharge/abscess/breakdown
Pus may release with palpation
+/- Systemic features of infection
Diagnosis
Diagnosed clinically
Investigations
Blood culture
Samples from infection site
Culture
Radiology
Assess deep soft-tissue/organ-space infection
Treatment/Prevention
Management
Wound care
Antibiotics
Clean surgery
Flucloxacillin
Contaminated surgery
Co-amoxicalv
Maybe surgery
Debridement
Drainage of abscess
Removal of prosthesis
Prevention
Multifaceted
Antimicrobial prophylaxis
Give shortly before operation
Depends on site of infection
