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Surgical Site Infections

What is a surgical site infection?

A surgical site infection, or SSI, is an infection of a wound you got from surgery. It may develop within the first 30 days after surgery. Oftentimes, SSI occurs 5 to 10 days after surgery. SSI may affect either closed wounds or wounds that were left open to heal. It may affect tissues on any level of your body. Infections may develop in superficial (close to the skin) or deep tissues. In more serious cases, SSI may affect body organ(s).

What causes a surgical site infection?

Surgical site infections are caused by germs, called bacteria. Different types of bacteria may reach the wound and cause infection. The bacteria may come from your skin or from the environment, such as soil, air, or water. They may come from the object that caused your wound or from tools used during the surgery. They may also come from inside the body, where they normally live without doing harm.

What puts me at risk of having a surgical site infection?

The risk of having an SSI depends on different factors. These factors include the following:

  • Diseases: Diseases, such as diabetes, cancer, and liver, kidney, or lung conditions may slow the healing process. Medical conditions, such as low blood protein may also affect healing.

  • Foreign objects: Dead tissues and foreign objects, such as glass or metal, present in the wound may delay wound healing. SSI may also be likely if you have an infection on another part of the body, or a skin disease.

  • Poor blood or oxygen supply: Blood flow may be affected by high blood pressure, and blocked or narrowed blood vessels. This may be a common problem in people who smoke, or have blood vessel problems or heart conditions. Low oxygen supply may be caused by certain blood, heart, and lung diseases.

  • Type of surgery: Your chances of having SSI is increased when surgery is done on an infected wound. Emergency surgeries on traumatic injuries, and surgeries lasting for 3 hours or longer, also increase your risk. This may also include surgeries done on certain body organs, such as the stomach or intestines (bowels). The risk may be greater if an object pierced through the skin and into an organ. SSI is more likely to occur after an open surgery than surgery using a scope. Having drains or blood transfusion may increase the chances of bacteria reaching the wound and causing infection.

  • Weak immune system: The immune system is the part of the body that fights infection. This may be weakened by radiation, poor nutrition, and certain medicines, such as anti-cancer medicines or steroids. Being overweight, or too young or too old, may also decrease your ability to respond to injury.

What are the signs and symptoms of a surgical site infection?

  • A wound that is painful, even though it does not look like it should be.

  • High or low body temperature, low blood pressure, or a fast heart beat.

  • Increased discharge (blood or other fluid) or pus coming out of the wound. The discharge or pus may have an odd color or a bad smell.

  • Increased swelling that goes past the wound area and does not go away after five days. Swollen areas usually look red, feel painful, and feel warm when you touch them.

  • Wounds that do not heal or get better with treatment.

How is a surgical site infection diagnosed?

  • Physical exam: Caregivers will look closely at the wound, including the area around it. He will check for swelling, discharge, and how much tissue is infected. He will also look for other problems or signs of spreading infection.

  • Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

  • Imaging tests: Pictures of your bones and tissues in the wound area may be taken using different imaging tests. Tests may include x-rays, magnetic resonance imaging (MRI), or bone scan. Caregivers use the pictures to look for broken bones, injuries, or foreign objects in the wound area.

  • Tissue biopsy and wound culture: This is when a small piece of tissue is removed from your wound. This sample is then sent to the lab for tests. The sample taken will also be checked to identify the germs in your wound. This helps caregivers learn what kind of infection you have and what medicine is best to treat it.

How is a surgical site infection treated?

You may need one or more of the following treatments:

  • Wound care:

    • Cleansing: This may be done by rinsing the wound with sterile (clean) water. It may be done using high pressure with a needle or catheter and a large syringe. Germ-killing solutions may also be used to clean your wound.

    • Debridement: This is done to clean and remove objects, dirt, or dead skin and tissues from the wound area. Caregivers may cut out the damaged areas in or around the wound. Wet bandages may be placed inside the wound and left to dry. Other wet or dry dressings may also be used. Caregivers may also drain the wound to clean out pus.

    • Wound cover: This may also be called a wound dressing. Dressings are used to protect the wound from further injury and infection. These may also help provide pressure to decrease swelling. Dressings may come in different forms. They may contain certain substances to help promote faster healing.

  • Medicines: Your caregiver may give you antibiotic medicine to fight infection. You may also be given medicine to decrease pain, swelling, or fever.

  • Hyperbaric oxygen therapy: This is also called HBO. HBO is used to get more oxygen into your body. The oxygen is given under pressure to help it get into your tissues and blood. You may be put into a tube-like chamber called a hyperbaric or pressure chamber. You will be able to see your caregivers and talk with them through a speaker. You may need to have this therapy more than once.

  • Negative pressure therapy: This is also called vacuum-assisted closure (VAC). A special foam dressing with an attached tube is placed inside the wound cavity and tightly covered. The tube is connected to a pump which will help suck out excess fluid and dirt from the wound. VAC may also help increase blood flow and decrease the number of bacteria in the wound.

  • Other treatment: Controlling or treating the medical condition that causes poor wound healing helps treat wound infection. You will need to regularly take medicines to control diseases such as diabetes or high blood pressure. Your caregiver may give you supplements or suggest a special diet to improve your nutrition and health. Surgery may also be done to increase blood flow if you have blood vessel problems.

How can a surgical site infection be prevented?

Surgical site infections may be prevented by controlling risk factors in cases of scheduled surgery. You may need to do any of the following before your surgery:

  • Do not smoke. If you smoke, you may need to quit as early as one month before your surgery.

  • If you have an open wound, clean it everyday to help it heal. You may need to take medicines if your wound is infected.

  • Try to lose weight if you weigh more than your recommended weight. Ask your caregiver for more information what your weight should be and how you can lose weight safely.

  • You may need to take supplements to improve your nutrition. You may also receive blood if needed.

  • Shower with a germ-killing soap the night before your surgery.

Where can I find more information?

You may contact the following for more information about surgical site infections:

  • American Academy of Family Physicians
    11400 Tomahawk Creek Parkway
    Leawood , KS 66211-2680
    Phone: 1- 913 - 906-6000
    Phone: 1- 800 - 274-2237
    Web Address: http://www.aafp.org
  • American College of Surgeons
    633 N. Saint Clair St.
    Chicago , IL 606113211
    Phone: 1- 312 - 2025000
    Phone: 1- 800 - 6214111
    Web Address: http://www.facs.org

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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