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.
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.
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%.
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.
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.
a) Preoperative Care: The following precautions need to be taken before a surgery is performed:
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.
Surgeons and other hospital staff in leading medical tourism destinations adopt the following practices to minimise surgical site infections:
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.