Surgical Site Infection Quiz

Understanding Surgical Site Infections (SSIs)

Surgical Site Infections (SSIs) are infections that occur after surgery in the part of the body where the surgery took place. They are a significant cause of morbidity, mortality, and increased healthcare costs. A thorough understanding of SSI classification, risk factors, and prevention is crucial for all healthcare professionals involved in the perioperative care of patients.

What are Surgical Site Infections (SSIs)?

An SSI is an infection related to a surgical procedure that occurs at or near the surgical incision within 30 days of the procedure (or within 90 days if a prosthetic implant is involved). They are caused by microorganisms, most commonly bacteria, that enter the body during surgery. Effective prevention requires a bundled approach, addressing factors related to the patient, the procedure, and the post-operative environment.

Classification of SSIs

The Centers for Disease Control and Prevention (CDC) classifies SSIs into three main types based on their location:

• Superficial Incisional SSI: This infection occurs only in the skin and subcutaneous tissue of the incision.
• Deep Incisional SSI: This infection involves deep soft tissues of the incision, such as fascial and muscle layers.
• Organ/Space SSI: This infection involves any part of the anatomy (e.g., organs or spaces) other than the incision, which was opened or manipulated during an operation.

Key Prevention Strategies

Evidence-based guidelines recommend a “bundle” of interventions to reduce SSI risk. These often include:

• Antimicrobial Prophylaxis: Administering appropriate antibiotics within 60 minutes before the surgical incision.
• Skin Preparation: Using an alcohol-based antiseptic agent for skin preparation in the operating room.
• Hair Removal: Avoiding razors for hair removal; clippers are preferred if removal is necessary.
• Glycemic Control: Maintaining blood glucose levels below 200 mg/dL in the immediate post-operative period.
• Normothermia: Maintaining normal body temperature throughout the perioperative period.

Patient-Related Risk Factors

Several patient factors can increase the risk of developing an SSI. Modifiable risk factors include smoking, obesity, uncontrolled diabetes, and poor nutritional status. Non-modifiable factors include advanced age and certain underlying medical conditions. Pre-operative optimization of these factors is a critical component of SSI prevention.

The Role of Antibiotic Prophylaxis

Surgical antibiotic prophylaxis aims to reduce the burden of microorganisms at the surgical site to a level that the patient’s immune system can manage. The choice of antibiotic depends on the type of surgery and the most likely pathogens. It is crucial that the antibiotic is given at the right time and discontinued within 24 hours after surgery to prevent antimicrobial resistance.

Wound Classification and SSI Risk

Surgical wounds are classified based on their level of contamination, which directly correlates with SSI risk:

• Class I (Clean): Uninfected operative wound in which no inflammation is encountered. Risk is ~1-5%.
• Class II (Clean-Contaminated): Operative wounds in which the respiratory, alimentary, or genitourinary tracts are entered under controlled conditions. Risk is ~3-11%.
• Class III (Contaminated): Open, fresh, accidental wounds or operations with major breaks in sterile technique. Risk is ~10-17%.
• Class IV (Dirty-Infected): Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. Risk is >27%.

This content is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.