What You Should Know About Surgical Site Infections

A surgical site infection is an infection which occurs in that part of the body where a surgery has been performed. These infections generally exist only on the surface or are skin deep. In more serious cases, these infections affect tissues under the skin, organs, or implanted material.


Causes And Risk Factors Of Surgical Site Infections

Surgical wounds become infected when germs that are already on the skin spread to the surgical wound. It may also happen because of germs that are inside the body or from the organ on which the surgery was performed. Surgical site infections can also be caused by the infected hands of the health-care provider or the infected surgical instruments.


Patients are more prone to acquiring surgical site infections if they have poorly controlled diabetes which results in a high concentration of sugar in the blood, have problems with the immune system, are smokers, or undergo surgeries that last for many hours which result in prolonged exposure to microorganisms.


Odds Of Being Affected By Wound Infections

The risk of wound infection varies with the type of surgery. Certain types of surgery carry a higher risk of contamination than others and have led to the following classification of surgical wounds:


  • Clean: A surgical wound is considered to be clean if the operative wound is uninfected, there is no acute inflammation and there is no entry of foreign objects in internal organs. In these cases, the risk of patients acquiring surgical site infections is less than 2%.


  • Clean - Contaminated: A surgical wound is classified as clean-contaminated if there is an opening to internal organs but minimal or no spillage of contents present in the concerned organs. Also, there should be no evidence of infection or major break in disinfecting technique. In these cases, the risk of patients acquiring surgical site infections is less than 10%.


  • Contaminated: A surgical wound is contaminated if there is an opening to internal organs with inflammation or spillage of contents of the organs involved and a major break in disinfecting technique. In these cases, the risk of patients acquiring surgical site infections is 15-20%.


  • Dirty: A surgical wound is called dirty if the inflammation discharges pus and there is abscess formation. In these cases, the risk of patients acquiring surgical site infections is about 40%.


Dangers Of Surgical Site Infections

Surgical site infections are often associated with substantial morbidity and mortality, prolonged hospital stay, and increased costs. Quality of life may also be adversely affected for patients with surgical site infections.According to a study of surgical site infections following orthopedic procedures, the occurrence of surgical site infections can in certain situations, account for increase in the rate of rehospitalization.

Treatments Of Surgical Site Infections 

Many closures are available for surgical wounds such as sutures, staples and adhesives. In some situations, the wound may be left open to heal. Depending on the surgical wound location and its type and complexity, drains, a tube like structure to remove fluids, may be sewn into the wound and allowed to stay for several days.


In addition to closing the surgical wound, a dressing is applied. Dressings come in many varieties and can range from sterile gauze covered with tape to a vacuum assisted closure device. Antibiotics are also given to the patient to prevent infection prior to and after surgery.


In addition to treating the surgical wound, surgical care is focused on supporting the body’s overall health to improve healing. This support includes maintaining good nutrition and hydration, reviewing blood circulation, along with oxygen supply in the body and providing proper rest.


How To Prevent Surgical Site Infections - Preoperative And Postoperative Care


a) Preoperative Care: The following precautions need to be taken before a surgery is performed:

  • Bathing: Patients should take a shower either a day before, or on the day of the surgery because bathing cleanses the skin and removes harmful bacteria from it.


  • Hair Removal: Hair removal should be avoided for at least 3-4 days before the surgery. If hair removal is necessary, electric clippers should be used on the day of the surgery. Razors should be strictly avoided as they increase the risk of infection.


  • Jewellery And Nail-Polish: Jewellery and nail polish should be removed before operations as they hide bacteria which may cause infections.


  • Antibiotics: A single dose of preventive antibiotics, which increase the patient’s resistance to harmful bacteria, should be taken by patients before clean surgeries involving the placement of prosthesis or implants, clean-contaminated surgeries and contaminated surgeries.


b) Postoperative Phase: The following precautions need to be taken after a surgery is performed:

  • Changing Dressings: An aseptic non-touch technique should be used for changing or removing surgical wound dressings.


  • Postoperative Cleansing: Sterile saline, a solution of sodium chloride used for flushing wounds and skin abrasions should be used for wound cleansing for up to 48 hours after surgery. Patients should avoid taking a shower until 48 hours have elapsed from the time of surgery for keeping the sutures (stitches) dry. Soaking the wound could cause the scar tissue to soften and reopen the wound.


  • Antibiotic Treatment Of Surgical Site Infection And Treatment Failure: When surgical site infection is suspected, the patient should be given an antibiotic that covers the likely causative organisms.


surgical site infection

Wound dressings should be changed regularly and flushed with a saline solution to minimise the risk of surgical site infections.

How Hospitals Minimise Surgical Site Infections?

Surgeons and other hospital staff in leading medical tourism destinations adopt the following practices to minimise surgical site infections:

  • Provide positive pressure ventilation in the operation room with at least 15 air changes per hour. Air changes through the exhaust vents remove airborne microorganisms to help control infection.


  • Keep the operation room doors closed for minimising the entry of airborne microorganisms


  • Use sterile instruments only


  • Wear surgical masks and sterile gloves to minimize risk of propagation of germs


  • Cover hair so that the hair does not fall on the surgical site and contaminate it


  • Maintain short nails since long nails are a breeding ground for harmful microorganisms


  • Ensure that surgeons/staff clean hands with appropriate agents and methods


  • Avoid delayed primary closure for heavily contaminated wounds


  • Exclude infected surgeons from operating on patients


Hospitals around the world have become conscious about taking these precautions for improving patient satisfaction and minimising future complications. With proper precautions on the part of patients as well as medical practitioners, surgical site infections can be easily avoided.

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