Moyale primaryHospital
Surgical Site Infection
Protocol
March 2024
Siraj A.A CG&QI
Contents
Surgical Site Infection.................................................................................................................................1
Types of surgical site infections...............................................................................................................2
Signs And Symptoms of Surgical Site Infections......................................................................................2
Causes and risk factors of surgical site infections....................................................................................2
Other risk factors for SSIs........................................................................................................................3
Surgical Site Infection (SSI) Assessment Checklist...................................................................................4
Surgical Site Infection
Definition
Surgical site infections (SSIs) are infections that occur at or near surgical incision within 30 days
of operation or after 1 year if an implant is placed. It’s an infection that occurs after surgery in
the part of the body where the surgery took place. Surgical site infections can sometimes be
superficial infections involving the skin only.
SSIs are a major cause of morbidity and mortality worldwide, affecting 5.6% of surgical
procedures in developing countries. According to a World Health Organization (WHO) report,
the incidence of SSIs ranges from 1.2 to 23.6 per 100 surgical procedures. Worldwide, it has
been reported that more than one-third of postoperative deaths are related to SSIs. In addition,
SSIs threaten the lives of millions of patients each year and contribute to the spread of antibiotic
resistance.
Despite improvements in prevention, SSIs remain a significant clinical problem as they are
associated with substantial mortality and morbidity and impose severe demands on healthcare
resources. The incidence of SSIs may be as high as 20%, depending on the surgical procedure,
the surveillance criteria used, and the quality of data collection. In many SSIs, the responsible
pathogens originate from the patient's endogenous flora. The causative pathogens depend on the
type of surgery; the most commonly isolated organisms are Staphylococcus aureus, coagulase-
negative staphylococci, Enterococcus spp. and Escherichia coli. Numerous patient-related and
procedure-related factors influence the risk of SSI, and hence prevention requires a 'bundle'
approach, with systematic attention to multiple risk factors, in order to reduce the risk of
bacterial contamination and improve the patient's defenses.
The Centers for Disease Control and Prevention guidelines for the prevention of SSIs emphasize
the importance of good patient preparation, aseptic practice, and attention to surgical technique;
antimicrobial prophylaxis is also indicated in specific circumstances. Emerging technologies,
such as microbial sealants, offer the ability to seal and immobilize skin flora for the duration of a
surgical procedure; a strong case therefore exists for evaluating such technologies and
implementing them into routine clinical practice as appropriate.
Types of surgical site infections
Centers for Disease Control and Prevention classify SSI by 3 categories
1. Superficial incisional SSI: - This infection occurs just in the area of the skin where the
incision was made.
2. Deep incisional SSI: - This infection occurs beneath the incision area in muscle and the
tissues surrounding the muscles.
3. Organ or space SSI: -This type of infection can be in any area of the body other than skin,
muscle, and surrounding tissue that was involved in the surgery. This includes a body
organ or a space between organs.
Signs And Symptoms of Surgical Site Infections
Any SSI may cause redness, delayed healing, fever, pain, tenderness, warmth, or swelling. These
are the other signs and symptoms for specific types of SSI:
A superficial incisional SSI may produce pus from the wound site. Samples of the pus
may be grown in a culture to find out the types of germs that are causing the infection.
A deep incisional SSI may also produce pus. The wound site may reopen on its own, or a
surgeon may reopen the wound and find pus inside the wound.
An organ or space SSI 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, is an enclosed
area of pus and disintegrating tissue surrounded by inflammation. An 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. The most common of these include the
bacteria Staphylococcus, Streptococcus, and Pseudomonas. Germs can infect a surgical
wound through various forms of contact, such as from the touch of a contaminated caregiver or
surgical instrument, through germs in the air, or through germs that are 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. Surgical wounds
can be classified in this way:
Clean wounds. These are not inflamed or contaminated and do not involve operating on an
internal organ.
Clean-contaminated wounds. These have no evidence of infection at the time of surgery, but
do involve operating on an internal organ.
Contaminated wounds. These involve operating on an internal organ with a spilling of
contents from the organ into the wound.
Dirty wounds. These are wounds in which a known infection is present at the time of the
surgery.
Other 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
Surgical Site Infection (SSI) Assessment Checklist
S.no Criteria Element Remark
(Chart review)
1. Date of Procedure performed
2. Date of event occurs within 30 days after any operative
procedure (where day after the procedure date)
3. Does the patient Diagnosis SSI by a physician* or physician Yes No
designed
4. Does the SSI Involves only skin and subcutaneous tissue of the Yes No
incision
5. Does the SSI have Purulent drainage from the superficial Yes No
incision?
6. Does Superficial incision that is deliberately opened by a Yes No
surgeon, physician* or physician assigned
7. Purulent drainage from the deep incision. Yes No
8. A deep incision that spontaneously dehisces, or is deliberately Yes No
opened or aspirated by a surgeon, physician* or physician
designee
9. Does Patient have at least one Localized pain or Yes No
of the following signs or tenderness
symptoms: Localized swelling Yes No
Erythema Yes No
Heat Yes No
10. Does the infection manage by senior physician/assigned Yes No
physician?
