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Surgical site infection

Definition
  • Surgical Site Infection (SSI): An infection that occurs after surgery in the part of the body where the surgery took place, which can involve the skin, tissues under the skin, organs, or implanted materials.
Types of SSI
  • Superficial incisional SSI: Involves only the skin or subcutaneous tissue of the incision.
  • Deep incisional SSI: Involves deep tissues (e.g., fascial and muscle layers).
  • Organ/space SSI: Involves any part of the body deeper than the muscle/fascial layers (e.g., organs or spaces accessed during the operation).
Risk Factors
  • Diabetes mellitus.
  • Smoking.
  • Malnutrition.
  • Advanced age.
  • Obesity.
  • Length of the surgical procedure.
  • Use of drains or foreign material.
  • Pre-existing infection.
  • Emergency surgeries.
  • Suboptimal sterilisation techniques.
Clinical Presentation
  • Redness, warmth, or swelling at the surgical site.
  • Purulent discharge from the surgical wound.
  • Fever and/or chills.
  • Pain or tenderness at the surgical site.
  • Delayed wound healing.
Investigations
  • Swab culture: To identify causative organisms.
  • Blood culture: Especially if sepsis is suspected.
  • White blood cell count: Can be elevated.
  • Imaging (e.g., ultrasound, CT scan): To assess deep infections or abscesses.
Management
  • Antibiotics: Tailored according to culture results.
  • Wound drainage if abscess formation occurs.
  • Regular wound cleaning and dressing.
  • Surgical debridement if required.
  • Address underlying comorbidities.
Prevention
  • Proper hand hygiene.
  • Antiseptic surgical scrubs.
  • Preoperative skin antisepsis.
  • Prophylactic antibiotics when indicated.
  • Sterilisation of surgical instruments.
  • Post-operative wound care education.

Understanding the risks and preventive measures associated with SSIs is crucial to reduce morbidity and healthcare costs associated with postoperative complications.

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