SURGICAL SITE

INFECTION (SSI)

Prepared by Nazleen Virani

SSI Nurse Ambulatory Care Services
 Flow Of talk
 Discuss the Importance of SSI

 Define SSI

 Discuss Types of SSI

 Over view of Risk Factor and its Prevention of SSI

 Explore CDC Criteria of SSI

 AKUH project

 Role of nurse

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 Importance

SSIs are the second most common

type of adverse event occurring in
hospitalized patients. It increases
Mortality
Readmission rate
Length of stay
Cost for patients who incur them.
(Odon, J. 2005)
 Surgical Site Infection
• A surgical site infection is an infection
that occurs after surgery in the part of
the body where the surgery took place.
Center of Disease Control and Prevention/National Healthcare safety network .Surgical
Site Infection Event (Updated January 2013)

• For non implant: Patient will be

monitored till 30 days of surgery

• For Prosthesis (Implant): Patient is

being monitored for 90 days after
surgery such as mesh, use of implants )

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 Types Of Surgical Site Infection

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 Surgical Wound closer categories

Primary closer:
Wound closed during surgery.

Secondary closer:
In secondary closer fascia closed but
skin and subcutaneous tissues left
open.

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 Risk factors
• Age • Inadequate
Disinfection • Preoperative
• Obesity
sterilization skin
• Diabetes • skin preparation
• Malnutrition antisepsis Hypothermia
• Smoking • ventilation • Inadequate
• Surgical antibiotics
• Preoperative
drains prophylaxis
stay • Foreign • Prolonged
• Immune material in operative time
compromise surgical site • Sterile
dressing

Patient Environment Treatment

 Criteria for SSI

 Purulent discharge from incision

 Culture sent for lab
 Surgeon opened wound in clinic or wound
dehisces spontaneously
 Doctor diagnose SSI
 Antibiotic prescribed for SSI.
 Sign of infections
 Fever
 pain and tenderness
 Localize swelling
 Redness and warmness
GUIDE LINE OF SSI

• Pre operative
 Do not shave the surgical site.
 Skin preparation
 Glucose control
 Stop use of nicotine
 Short hospital stay
 Hand washing (surgical and medical)
 Antimicrobial prophylaxis.
HICPAC and CDC guide line of SSI 2010
 Cont…

• Intra operative
 Ventilation
 Hypothermia
 Stop personnel traffic in OR
 Disinfectant environmental surface
 Sterilize instruments
 Maintain surgical field

HICPAC and CDC guide line of SSI 1999

 Cont…

• Post operative
 Remove dressing after 48 hours
 Hand washing before and after procedure.
 Use sterile technique
 Educate incision care and sign of infection
 Use high calorie diet.
 Other SSI prevention Measures
• Encourage patient tobacco
cessation prior to surgery

• Ask patients to shower or bathe with antiseptic

agent on at least the night before the operative
day
(CDC Guideline for Prevention of Surgical Site Infections, 2010)
 Other SSI prevention Measures

• Ill surgical staff refrain from working

• Surgical team keeps nails short
• Surgical team performs appropriate hand /
forearm
antisepsis prior to surgery
(CDC Guideline for Prevention of Surgical Site Infections, 1999)
 Other SSI prevention Measures
• Surgical team wears appropriate surgical attire

• Uses proper aseptic and surgical technique

during procedures

• Use appropriate antiseptic agent for skin

(CDC Guideline for Prevention of Surgical Site Infections, 1999)
 Other SSI prevention Measures
• Protect closed incision with sterile dressing for
24-48 hours postoperatively

• Maintain adequate/recommended ventilation

processes in the operating rooms

(CDC Guideline for Prevention of Surgical Site Infections, 1999)

 AKUH working on 4 sub specialty and 9
Procedures
►General surgery: ►Paeds Surgery:

Laparoscopic Hernia repair (Paeds)

cholecystectomy Orchidopexy
►Orthopedics:
Hernia repair Adult
Total knee Replacement
Wide local excision/ Total Hip Replacement
mastectomy ►Neurosurgery:

►Urology: Unilateral single level

Nephrectomy Microdisectomy
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 Short Over view Of organism
Organism Characteristics/ Habitat

Gram Positive cooci. It is Normal flora of Skin but easily

S. Aureus
transmit through contact to Infected Patient.
Habitat in Human Colon. Mainly cause UTI. Indwelling
Escherichia Coli
catheter

Klebsiella Habitat in human Upper Respiratory and enteric tract.

Pneumoniae Also transmit by Droplets or through hospital equipment

Pseudomonas Habitat in large intestine, water and soil. Developed

aeruginosa easily in immuno compromised patients

Beta hemolytic Habitat in Human Throat. commonly caused pharyngitis

Streptococci A
Habitat in Soil, and water. Infection occur usually in
Acienatobacter hospital settings by handling Respiratory therapy
equipment and catheters
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Role of nurse
 Assess wound by using
۩ S= Site of wound
۩ C= Color
۩ O= Oozing
۩ O= Odor
۩ T= type of wound
۩ I= infection sign
 To observe sutures and staples
 Document your finding in nursing notes of wound.
 Inform SSI Nurse and Doctor
 Discharge teaching
• Patient with close wound must informed about.
• Surgical site care
• Sign of infection
• Activity
• Exercises
• Important of diet
• Pain medication
• Follow up
 References
• Kiernan, M. (2012). Reducing the risk of surgical site
infection. Nursing Times; 108: 27, 12-14.

• Patient Risk Factors and Best Practices for Surgical Site

Infection Prevention by Suzanne M. Pear, RN, Ph.D, CIC
managing infection control March 2007

• Center of Disease Control and Prevention/National Healthcare

safety network .Surgical Site Infection Event (Updated January
2013)

• Levinson, W. (2010). Review of medical Microbiology and

immunology 11th edition.

• http://www.cdc.gov/hai/ssi/ssi.html
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