Table Of Contents
Classification
Classification of SSI
| Surgical Site Infection | Description | Signs and Symptoms | Onset |
|---|---|---|---|
| Superficial | Involves the skin and SC tissue. A form of cellulitis brought onto the incision site. | Purulent discharge from incision, Fever, Tenderness, Erythema, Warmth, Swelling | Within 30 days post-op |
| Deep | Involves the fascial and/or muscular layer. | Purulent discharge from deep within incision, Fever, overlying erythema, warmth, pain, focal induration, Dehiscence | Within 30-90 days post-op. Infection of prosthesis may occur 1 year post-op |
| Organ-space | Involves organs and cavities operated on in the form of abscess or serositis (peritonitis) | Purulent discharge from drain, fever | Within 30-90 days post-op. Infection of prosthesis may occur 1 year post-op |
Surgical Site Infection
Common cause of post-op fever around one week after surgery (5-7). Risk depends on pre-surical care, factors going in, the mechanism of injury, contaminants etc. Remember that all surgical wounds have bacteria, but the body’s intrinsic defenses prevent infection. Think of risks as being dependent on the patient, wound, surgeon, and post-op care. Diagnosis is clinical but if unsure whethere it is cellulitis or an abscess get and ultrasound. Always get a culture.
Of all surgeries (sterile) 2.8% develop SSI.
- Systemic (patient) risk factors
- Old age
- Immunosuppression
- Drugs (steroids, other immuosuppresants)
- Diabetes Mellitus
- Malnutrition
- Smoking
- Cancer
- Local (wound) risk factors
- Previous infection
- Poor debridement
- Operating (surgeon) risk factors
- Poor sterile technique
- Prolonged surgery
- Poor suturing quality
- Signs and symptoms
- Superficial infections (cellulitis): surrounding erythema, warmth, pain, fever often present
- Deeper infections (abscess): overlying erythema, warmth, pain, focal induration, fever may be present
- Treatment
- Incision and drainage for abscess
- Antibiotics for both cellulitis and abscess
- Complications of SSI
- Wound dehiscence
- Adhesions
- Sepsis
