Surgical infection

Prof. Dr. Kamal Koirala

Department of Surgery
 Surgical infection
• Infection relevant to surgery

• SSI abscess
cellulitis/lymphangitis gas gangrene
tetanus necrotising fasciitis
bacteraemia septicaemia
hepatitis HIV
 Surgical site infection
• Surveillance of the wound for 30 days/90 days
• CDC NHSN
major SSI
minor SSI
superficial SSI
deep SSI
organ/space SSI
SSI definition

based on

site of infection/type of incision

presence of pus
signs and symptoms
physician Dx
specimen microbiology
Risk factors for increased risk of SSI
• Patient factors
• Preoperative measures
• Operative characteristics
• Post operative issues
 Patient factors

reduced host resistance to infection

• metabolic disease
diabetes, uraemia, jaundice, malnutrition .obesity,
weight loss
• immunosuppression
cancer, AIDS, steroids, chemotherapy and radiotherapy
• colonisation and translocation in the gastrointestinal tract
• poor perfusion (systemic shock or local ischaemia)
• foreign material
 Pre-operative physical condition
ASA score
• Class I
• Class II
• Class III
• Class IV
• Class V
 Surgical wound classification
• Clean
• Clean contaminated
• Contaminated
• Dirty
 Prevention of SSI

• Preoperative
• Intraoperative
• postoperative
optimise patient factors
smoking cessation
treat remote infection
bowel preparation in colon surgery
bathing
short hospital stay
 OR
• Hair removal
• Surgical scrub
• Surgical site preparation
• Antibiotic prophylaxis
• Prevent hypothermia
• Surgical procedure
Post op

wound care
 Treatment of SSI
• bacteria
• antibiotics
Thank you