SURGICAL SITE
INFECTIONS
Presented by:
K.Lokagna (roll no:101)
K.Amrutha reddy (roll no:102)
DEFINITION:
• Surgical site infections (SSI) are defined as infections that
develop at the surgical site within 30 days of surgery (or within
90 days for some surgeries such as breast, cardiac and joint
surgeries including implants).
Symptoms include:
• Redness and pain around the area
• Drainage of cloudy fluid from that area
• Fever
MICROBIOLOGY:
1. Endogenous source: include patients own flora present
• Skin: S. aureus (the most common organism causing
SSI, coagulase negative staphylococci (CoNS)
• Mucosa: aerobic gram-negative bacilli (E.coli, Klebsiella), gram-
positive cocci (Enterococcus) and anaerobes such Bacteroides, and
others.
2. Exogenous source:
from contact with external
environment: S. aureus and
gram-negative bacilli
including nonfermenters
such as
Pseudomonas and
Acinetobacter
PATHOGENESIS:
• When host defense
mechanisms fail to
eliminate the microbial
contamination,
compounded by the
greater load and higher
virulence of the invading
microbes,leads to
development of SSI.
RISK FACTORS:
1. Patient-related: Age >60 years, malnutrition, diabetes,
Immunosuppression
2. Procedure-related: Prolonged operative time, improper
surgical scrub
3. Organism-related: Large Inoculum size (e.g. bowel surgery),
bacterial virulence
4. Environmental-related: Presence of blood/ clot, foreign
bodies at the surgical site, etc
CLASSIFICATION AND
DIAGNOSIS:
1.Superficial SSI :-develops at the level of
superficial incisional site (skin and
subcutaneous level) within 30 days for all
surgeries
2.Deep SSI :-develops at the level of deep
incisional site (muscle and facial level) within
30 days
3.Organ space : SSI-develops at the level of
organ space site within 30 days
TREATMENT:TREATMENT OF SSI INCLUDES SUTURE
REMOVAL PLUS INCISION AND DRAINAGE WITH ADJUNCTIVE
SYSTEMIC ANTIMICROBIAL THERAPY.
PREVENTION OF SSIS :
1. Pre operative
2. Intra operative
3. Post operative
RE OPERATIVE MEASURES:
1. Preoperative bathing: It should
be performed using a plain soap
or anti microbial soap
2. For MRSA carriers:
Decolonization with mupirocin
ointment is done (nasal carriers
of mrsa)
3. Hair removal: it is done only
with a clipper Shaving is
strongly discouraged at all times
INTRA OPERATIVE MEASURES
:
1. SAP: Surgical antimicrobial prophylaxis
should be provided
2. Surgical hand disinfection- is done with
antimicrobial soap (chlorhexidine) or alcohol-
based hand rub.
3. Surgical site preparation-is done with
alcohol-based chlorhexidine antiseptic
solution
4. Perioperative maintenance is done
ST OPERATIVE MEASURES:
1. Wound dressing-
Daily dressing of surgical site and
removal of discharge is done
2. OT disinfection-
Is done with high level disinfectant
(terminal disinfection)
3. Periodic monitoring :
of air exchanges, temperature,
humidity, pressure and microbial
contamination is done.
MCQS
• 1)What is the most common organism
responsible for SSIs from endogenous
sources?
a) Escherichia coli
b) Klebsiella
c) Staphylococcus aureus
d) Pseudomonas
ANSWER:
C
• 2)What are the organism-related risk factor for
the development of SSI?
a) Inadequate skin antisepsis
b) Emergency procedures
c) Inoculum size
d) Smoking ANSWER
:
C
• 3) Which of the following is not correct step in
the management of SSI?
a) Removing sutures
b) Performing incision and drainage
c) Administrating systemic antibiotics
d) Ignoring systemic symptoms if localized
ANSWER:
D
• 4) Which of the following may have SSI
development window of up to 90 days?
a) Appendectomy
b) Cardiac and joint surgeries including implant
c) Dental surgery
d) All types of surgery
ANSWER
:
B
• 5) Which of the following is a procedure -
related risk factor for SSI?
a) Malnutrition
b) Smoking
c) Prolonged operative time
d) skin colonization at the time of surgery ANSWER
:
C
THANK YOU…
