SURGICAL SITE

INFECTIONS
an update
working protocol
Dr.T.V.Rao MD

22-02-2016

Dr.T.V.Rao MD

Beginning to know
Microbes cause Infections
Louis Pasteur had just disproved the common
belief that microbes spontaneously came into
existence on substrates like meat broth. By
proving instead that dust and air carried the
germs, he ushered in the golden age of
microbiology and anchored the growing Germ
Theory of illness - that germs caused and
spread disease. In 1861, 26% of all Civil War
amputations resulted in death because of our
inability to control germs. At that point,
amputation was actually the best possible
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Dr.T.V.Rao MD

In spite of many advances we

are still with many
Surgical
Site
Its disappointing,
Infections
then, that the CDC

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currently predicts 1 of
every 3 surgeries
today in the U.S. will
result in an infection.
While fewer of those
will be fatal than the
Civil War surgeries,
pain and suffering are
inevitable (along with
other complications).

Dr.T.V.Rao MD

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. Surgical
site infections can
sometimes be
superficial infections
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Dr.T.V.Rao MD

Every Surgical Procedure has an

Impact
Infections that occur in the
wound created by an
invasive surgical
procedure are generally
referred to as surgical site
infections (SSIs). SSIs are
one of the most important
causes of healthcareassociated infections
(HCAIs).
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Dr.T.V.Rao MD

We are Underestimating Surgical

Site Infections
SSIs accounted for 14% of
these infections and
nearly 5% of patients who
had undergone a surgical
procedure were found to
have developed an SSI.
However, prevalence
studies tend to
underestimate SSI
because many of these
infections occur after the
patient has been
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Dr.T.V.Rao MD
discharged from hospital

Identifying a Surgical site

Infection a priority

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SSIs are associated with considerable morbidity and it has

been reported that over one-third of postoperative deaths are
related, at least in part, to SSI. However, it is important to
recognise that SSIs can range from a relatively trivial wound
discharge with no other complications to a life-threatening
condition

Dr.T.V.Rao MD

Out Come of Surgical Site

Infections
Other clinical outcomes of
SSIs include poor scars
that are cosmetically
unacceptable, such as
those that are spreading,
hypertrophic or keloid,
persistent pain and
itching, restriction of
movement, particularly
when over joints, and a
significant impact on
emotional wellbeing
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Dr.T.V.Rao MD

Surgical Site Infection

Other surgical site
infections are more
serious and can
involve tissues
under the skin,
organs, or
implanted material.
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Dr.T.V.Rao MD

Symptoms include
Redness and pain
around the area
where you had
surgery
Drainage of cloudy
fluid from your
surgical wound
Fever
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Dr.T.V.Rao MD

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After surgery

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If you do not see your providers clean their hands, please ask
them to do so.

Family and friends who visit you should not touch the surgical
wound or dressings.

Family and friends should clean their hands with soap and
water or an alcohol-based hand rub before and after visiting
you. If you do not see them clean their hands, ask them to
clean their hands.

Dr.T.V.Rao MD

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Caring the Wound and Hand

Washing a Priority
Make sure you
understand how
to care for your
wound before you
leave the hospital.
Always clean your
hands before and
after caring for
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Dr.T.V.Rao MD

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Contacting Surgeon
or
If you have any
Nurse is a symptoms
Priorityof an

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infection, such
as redness and
pain at the
surgery site,
drainage, or
fever, call your
doctor

Dr.T.V.Rao MD

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What are some of the things that

hospitals are doing to prevent SSIs
To prevent SSIs, doctors, nurses, and other
healthcare providers should follow CDC
infection prevention guidelines including:
Clean their hands and arms up to their
elbows with an antiseptic agent just before
the surgery.
Clean their hands with soap and water or
an alcohol-based hand rub before and after
caring for each patient.
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Dr.T.V.Rao MD

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Trends to Control the Surgical

Site Infections
If indicated, remove some of your hair immediately before
your surgery using electric clippers if the hair is in the same
area where the procedure will occur.
Wear special hair covers, masks, gowns, and gloves during
surgery to keep the surgery area clean.
When indicated, give you antibiotics before your surgery
starts. In most cases, you should get antibiotics within 60
minutes before the surgery starts and the antibiotics should
be stopped within 24 hours after surgery.
Clean the skin at the site of your surgery with a special soap
that kills germs.
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Dr.T.V.Rao MD

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Out Come of Surgical site

Infections
SSI can double the length of time a patient stays in
hospital and thereby increase the costs of health
care. Additional costs attributable to SSI have been
reported depending on the type of surgery and the
severity of the infection. The main additional costs
are related to re-operation, extra nursing care and
interventions, and drug treatment costs. The
indirect costs, due to loss of productivity, patient
dissatisfaction and litigation, and reduced quality of
life, have been studied less extensively
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Dr.T.V.Rao MD

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Who should monitor surgical site

Infections in developing countries
Surgeons
Microbiologist
Theatre nurse
Surveillance coordinator
Infection control specialist
Medical Superintendent
Representative of the
Hospital Management for
timely funding

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Dr.T.V.Rao MD

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Who should be responsible for

taking decisions on Surgical site
Infections

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The appropriate treatment of established SSIs requires careful

monitoring and communication between the multidisciplinary
postoperative team (surgeons, intensivists, microbiologists,
and the primary care team. If patients are to be returned
home early then any SSI needs to be recognised and treated
appropriately

Dr.T.V.Rao MD

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Decision Making in Surgical

Site Infections
Release of pus, debridement
and parenteral antibiotics, if
indicated, usually requires a
return to secondary care.
Extensive wound breakdown
may need specialist wound
management to reduce
bacterial burden in the open
wound. Wound bed preparation
may be required to encourage
healing by secondary intention
or facilitate secondary suture.
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Dr.T.V.Rao MD

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Bring in Better Coordination with

many Professionals
During the
development of the
guideline, we need
expert advice from an
anaesthetist and
additional clinical
representation from a
surgeon and a
theatre nurse.
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Dr.T.V.Rao MD

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Better care of the Environment is a

priority
Studies show that the opening and closing
of doors during surgery allow for the entry
of bacteria-carrying particles, which pose
the risk of infection. While a closed-door
policy would be unfeasible for the dynamic
environment of todays operating room, it
is undoubtable that decreasing traffic into
and out of the operating room during
surgery would go a long way toward
reducing the risk of infection
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Dr.T.V.Rao MD

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Other effective measures in

Surgical site Infections
Prophylaxis and
management of antibioticresistant bacteria
Management of the
operating theatre
environment and
environmental factors
Anaesthetic factors relating
to SSI.
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Dr.T.V.Rao MD

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The science of Infection ischanging

everysearches
minute
Initial scoping
Literature search
strategy
were
executed to

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identify relevant
guidelines (local,
national and
international)
produced by other
development groups.
The reference lists in
these guidelines were
checked against
subsequent searches
to identify missing

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Today We are Lucky to

prevent Infections
One and a half
centuries later, we
have hand hygiene,
antibiotics,
disinfectants, sterile
fields and sterile
instruments, heck we are performing
brain surgery with
lasers attached to
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Dr.T.V.Rao MD

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Other New Advances to

Reduce Surgical Site
Infections
Antibacterial sutures, which
are sutures coated with
antibiotics, were developed
to help the wound healing by
reducing the risk of surgical
site infections. Triclosancoated sutures may be one of
the most effective
antimicrobial agents
developed and we are
expected to greatly
contribute to decreasing SSIs

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Dr.T.V.Rao MD

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New Advances to Reduce

Surgical Site IfInfections
combined with

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refined and aseptic

surgery techniques
and the proper use of
prophylactic
antibiotics. This might
help to decrease the
length of hospital stay
for patients
undergoing gastric
cancer surgery.

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Reassure Patients with

Surgical Site Infections

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Dr.T.V.Rao MD

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Many Peer Reviewed Studies Indicate

that Hand Washing still a Great priority

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Dr.T.V.Rao MD

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Dr.T.V.Rao MD

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Attention of Viewers
I am thankful to many in the world who made me to achieve my desired goals faster than
I thought, having > 3-5 million health professionals share and utilize my knowledge for the
benefit of mankind, Today I wish to be freelancer to the world to create interest in
Medical, Clinical and Diagnostic Microbiology with more emphasis on Infectious diseases
and Hospital associated Infection wish to be your partner in educating many millions who
know well the importance of Infectious diseases

You can visit many web sites of mine

www.medmicrobes.com
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Raos Microbiology
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Microbiology connected Travancore Medical College
For any assistance on INFECTION REALTED ISSUES CONTACT ME AT doctortvrao@gmail.com

Mob +91 7204113154

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 Program Created by Dr.T.V.Rao MD for

Benefit of Medical and Paramedical
Professionals in the Developing World
Created from World Wide Resources
Email
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doctortvrao@gmail.com
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