Surgical infection

Dr. Ibrahim Alburaihi

 Wound infection
• Operative wound infection
• Surgical wound infection
• Surgical site infection
• Wound infection
 Wound infection
• Important definition
 Colonization .
 no sign or symptom of systemic inflammation
 bacteria count less than 10/5 per cm3
 Contamination
 transient exposure to bacteria
 time of exposure < 6 hr
 Infection
 local & systemic sign of inflammation.
 bacteria count > 10/5 per cm3
 Wound infection /SSI

• 3ed most common nosocomial

infection
 Wound infection /SSI

• It define as Invasion of organism into tissues

following a break down of local and systemic
host defense leading to either cellulitis ,
lymphangitis , abscess formation or
bacteremia .
 Wound infection /SSI

• It is define as infection present in any

location along the surgical tract after surgical
procedure within 30 days of procedure or up
to 1 year if procedure included implant
 Wound infection /SSI
 Classification of SSI

• Super fascial SSI

skin , subcutaneous
• Deep SSI
fascia , muscle
• Organ / space SSI
 Wound infection /SSI
 Classification surgical wound
• Clean
• Clean contaminated
• Contaminated
• Dirty
 Wound infection /SSI
 Risk factors
• General /patient factors
• Local factors
• Microbial factors
 Wound infection /SSI
 Patient risk factors
• Age/elderly
• Malnutrition
• Obesity
• DM
• Malignancy
• Prolong steroid use
• Immunosuppressive disease
• Anemia
• Chronic inflammatory disease
 Wound infection /SSI
 Local risk factors
• Type of wound
• Bad surgical technique
• Local tissue necrosis
• Prolong procedure (>4hr)
• Poor skin preparation
• Contaminated instrument
• Implant
 Wound infection /SSI
 Microbial risk factors
• Virulence
• Bacteria resistant
• Loud of inoculum
• Pre existed remote body infection
 Wound infection /SSI
 Causative organism
• Streptococci (pyogenes , fecalis)
• Staphylococci (aureus , epidermidis )
• Clostridia (perfingens , tetani , difficile )
• Gram negative bacilli (E.colli , klebsiella, proteus, pseudomonas)
• Bacteroid
 Wound infection /SSI
• Preventives measures

Better to prevent than to treat

 Pre- operative,
 intra-operative,
 post-operative
 Wound infection /SSI
 Pre-operative preventive measures
• Pre op. Short hospital stay
• Pre-op hair removal (30 min)
• Pre-op shower
• Per-op antibiotic (prophylactic )
• Control blood sugar
• Pre-op bowel preparation
• Optimized nutrition
• Stop smoking
 Wound infection /SSI
 Intra- operative preventive measures
• Strict aseptic technique
• Skin preparation
• Gowning & draping
• Theater control (number of staff, movement, regular surveillance , ventilation,
temperature )
• Good surgical tech ( hemostasis, debridement, dead space, appropriate suture, appropriate
approximation, dedicated tissue handling, justify drain use)

• Delayed primary closure if indicated

• Optimizing fluid ,O2 supplement
 Wound infection /SSI
 Post-operative preventive measures
• Keep wound covered for the 1st 48 hr
• Dressing any soaked-dress
• Early enteral nutrition
• Blood sugar control
• Follow infection control policy
 Wound infection /SSI
 Clinical features
 Symptom
• Pain , fever , discharge
• 5-7 day post operative
• History of risk factor
 Wound infection /SSI
 Signe
 Local
• Edema
• Hyperemia
• Discharge
• Gapping wound edge
• Tenderness
 Systemic /sepsis
Wound infection /SSI
 Wound infection /SSI
 Investigation
• Wound swab
• CBC
• S. electrolyte
• Ultra sound
• C T scan
 Wound infection /SSI
 Treatment
• Open the wound
• Drain any collection
• Started empirical antibiotic
• Wound care
• Correct any risk factors
• Manage complication
 Wound infection /SSI
 Complication
• Abscess
• Septicemia
• Sinus
• Wound dehiscence
• Weak ugly scar
 Specific local wound infection

 Gas gangrene
 Clostridium tetani
 Necrotizing fasciitis (synergistic spreading gangrene)
 Specific local wound infection
 Gas gangrene
• C. perfringens , anaerobic , gram +
• Spore bearing , live in soil
• Affect military & trauma wound
• Systemic manifestation
• Local crepitus , sweet smelling
• X-ray gas in subcutaneous
 Specific local wound infection
 Tetani
• C. tetani , spore bearing , gram +
• Civilian ,trauma, minor wound
• Toxin affect motor neuron of anterior horn of
spinal cord
• Short prodromal period /bad prognosis
• ATS for all trauma /debridement
• Toxoid vaccine
 Specific local wound infection
 Necrotizing fasciitis
• Mixed pattern of organism
• Immunocompromised patient
• meleney’s synergestic (abdominal wall inf.)
• Fournier’s gangrene (perineum inf. )
• Subdermal spread
• Systemic manifestation
• Systemic antibiotic
• Aggressive debriedment
Wound infection /SSI

Thanks