Surgical Site Infections, New Guidelines, Research and General Information
Background
According to the Johns Hopkins Medical Health library, skin is a natural barrier against infection and although surgery has many precautions and protocols to prevent infection in place, any surgery that causes a break in the skin can lead to an infection.These infections are referred to as surgical site infections (SSIs) because they occur on the part of the body where the surgery took place. If you have surgery, the chances of developing an SSI are about 1% to 3%. They typically occur within 30 days after surgery.Impact of surgical infection
They threaten the lives of millions of patients worldwide each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. |
| Books on surgical site infections in our library |
Types of surgical site infections, their signs and symptoms
Superficial incisional SSI-
infection just in the area of the skin where the
incision was made. Surgical site
infection may produce pus from the wound site.
Deep incisional SSI-
infection beneath the
incision area in muscle and the tissues surrounding the muscles. Surgical site
infection may also produce pus, wound site may reopen on its own, or a surgeon
may reopen the wound and find pus inside the wound
Organ or space SSI-
infection in any area of the body other than
skin, muscle, and surrounding tissue that was involved in the surgery including
body organ or a space between organs. Surgical
site infection may show a discharge of pus coming from a drain placed through
the skin into a body space or organ. A collection of pus, called an abscess, abscess
may be seen when the surgeon reopens the wound or by special X-ray studies.
Causes and risk factors of surgical site infections
Infections after surgery are caused by germs such as the bacteria Staphylococcus, Streptococcus, and Pseudomonas. Germs infect a surgical wound through contact with wound-touch of a contaminated caregiver or surgical instrument,
-germs in the air,
-germs already on or in your body and then spread into the wound.
The degree of risk for an SSI is linked to the type of surgical wound you have.
·
-Clean wounds are not inflamed or
contaminated and do not involve operating on an internal organ.
·
-Clean-contaminated wounds have no
evidence of infection at the time of surgery, but do involve operating on an
internal organ.
·
-Contaminated wounds involve operating on
an internal organ with a spilling of contents from the organ into the
wound.
·
-Dirty wounds in which a known
infection is present at the time of the surgery.
Some risk factors for SSIs:
·
Having surgery that lasts more than 2 hours
·
Having other medical problems or diseases
·
Being an elderly adult
·
Being overweight
·
Smoking
·
Having cancer
·
Having a weak immune system
·
Having diabetes
·
Having emergency surgery
·
Having abdominal surgery
Strategies to prevent surgical site infections
WHO 2016 Guidelines
World Health Organisation (WHO) has come up with guidelines to help prevent surgical site infections. Two significant guidelines include
-People preparing for surgery should always have a bath or shower but not be shaved,
and antibiotics should only be used to prevent infections before and during surgery, not afterwards
These and other recommendations are found in The "Global Guidelines for the Prevention of Surgical Site Infection" . Guidelines include 13 recommendations for the period before surgery, and 16 for preventing infections during and after surgery. They range from simple precautions such as ensuring that patients bathe or shower before surgery and the best way for surgical teams to clean their hands, to guidance on when to use antibiotics to prevent infections, what disinfectants to use before incision, and which sutures to use
Guidelines also recommend that antibiotics be used to prevent infections before and during surgery only, a crucial measure in stopping the spread of antibiotic resistance. Antibiotics should not be used after surgery, as is often done.
A pilot study in 4 African countries showed that implementing a selection of the new recommendations could result in a 39% reduction in surgical site infections.
Other Recommendations
-Follow post operation instructions about wound care
-Alert medical staff to development of fever or
pus, redness, heat, pain or tenderness near the wound or any other signs or
symptoms of a surgical site infectionReferences
1. http://www.hopkinsmedicine.org/healthlibrary/conditions/surgical_care/surgical_site_infections_134,144/
2. https://www.ncbi.nlm.nih.gov/pubmed/24103215
3. Global guidelines on the prevention of surgical site
infection
Book location http://www.who.int/entity/gpsc/global-guidelines-web.pdf?ua=14. http://www.who.int/entity/patientsafety/safesurgery/sssl_checklist_front-thumb.gif
5. http://www.who.int/mediacentre/news/releases/2016/recommendations-surgical-infections/en/
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