Wound Care: Surgical Site Infection (SSI)

Surgical Site Infection (SSI)

Definition

  • Infection Related to a Surgical Site
  • Occurs Near the Surgical Site within 30 Days of the Surgery
    • Within 90 Days if an Implant is Used

CDC Classification

  • Superficial: Limited to Skin or Subcutaneous Tissue
  • Deep: Involves Muscle or Fascia
  • Organ/Space: Involves Body Cavity or Organ

Surgical Wound Classification & Risk of SSI

Risk Factors

  • Patient Risk Factors:
    • Obesity
    • Malnutrition/Low Serum Albumin
    • Diabetes
    • Immunosuppression/Steroids
    • Smoking
    • Heart Failure
    • Advanced Age
    • COPD
    • High ASA Score
  • Intraoperative Risk Factors:
    • Emergency Nature
    • Prolonged Operative Time
    • Blood Transfusion
    • Enterotomy
    • Bowel Resection
    • Hypothermia
  • Hematoma or Seroma

Microbiology

  • Majority are From Native Flora (Skin, Mucous Membranes or Hollow Viscera)
  • Most Common Organism: Staphylococcus aureus
    • Most Common GNR: Escherichia coli
    • Most Common Anaerobe: Bacillus fragilis

Diagnosis

  • Superficial SSI Primarily Diagnosed by Physical Exam
  • Imaging (US/CT) Used to Evaluate Deeper SSI

Management

  • Primary Treatment: Antibiotics, Wound Exploration & Debridement/Drainage
    • Can Avoid Antibiotics for Superficial SSI with No Cellulitis
  • Most Important Determinant of Antibiotic Success: Adequate Source Control
  • Organ/Space SSI May Require Surgical or Percutaneous Drainage

Special Considerations