Surgical site infections Role of Diagnostic Microbiology

1. Surgical Site Infections –Role of Diagnostic Microbiology-
Dr.T.V.Rao MD
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 involving the skin
only. Other surgical site infections are more serious and can involve tissues under the skin, organs,
or implanted material. It is coordinated efforts of Surgeons and Microbiologist to educate the staff
and Doctors to the concerns associated with infection.To prevent surgical site infections, doctors,
nurses and other healthcare providers will take several measures to ensure that the surgical site is as
clean as possible, including:
Cleaning their hands and arms up to the elbows with an antiseptic agent just before the surgery
Wearing hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean
Cleaning the skin at the surgery site with a special soap that kills germs
In the present contest many of our patients are discharged as early as possible to get back to work
and also the hospital costs are increasing, many patients come back to our outpatient departments
to get the dressing changed, outpatient surgery centres, are one setting where there has been
significant growth in recent years both in number and in the type and complexity of procedures
performed. Ensuring patient safety in all settings is a priority for the Hospitals as a whole, and we
should take our work scientifically to prevent several infections spread in dressing rooms. All
healthcare facilities should take this as an opportunity to evaluate their current infection control
policies and, more importantly, make sure their staff understands and follows them. It is the duty of
the Seniors Nurses to educate the junior staff to attend the patients when they are changing the
dressings with scientific spirit.
What the Bacteriological culture means to Surgeons and Physicians
1 In Patients who undergo a surgical procedure if infected,An appropriate sample should be selected
in line with your local clinical and diagnostic facilities.
2 The specimens should the collected with care and caution as per the demands of the Microbiology
Department.
3Training is provided to hospital staff to facilitate compliance with the surveillance protocol. Each
hospital collects data prospectively on all eligible patients in a self-selected surgical category over a 3
month period.
4 The Bacteriological reporting carries the importance that it has to be supervised by Senior
Microbiologists who have knowledge in Clinical Microbiologyand analysis has shown that there is
considerable heterogeneity in the trends between surgical categories. The factors underpinning
these trends are likely to be related to patient and peri-operative factors. Although many patient-
related risk factors are non-modifiable there are several aspects in the peri-operative phase that can
be optimised to minimise the risk of SSI to the patient. These include glucose control and compliance
with guidelines on surgical antibiotic prophylaxis relating to the choice, frequency, dose and timing
of the antimicrobial agents

2. Preparing to Collect the Swabs from Wounds-
The person collecting specimens should decontaminate hands to reduce the risk of transfer of
transient organisms on the healthcare workers hands to the patient. Apply gloves (remove dressing
as appropriate) to protect the health care workers hands.
The wound should be cleansed with sterile saline to irrigate any purulent debris (Stotts 2007) to
achieve a clean culture site and to avoid obtaining a culture from the pus on the surface of the
wound. Moisten the swab with sterile saline before taking sample. In dry wounds a moistened swab
will attach bacteria more effectively.
Always take a swab from a newly cleaned wound. Cleanse with normal saline or sterile water
Take a swab by moving in a “Z” patternover the wound and turning the swab at the same time
Punch biopsy to be taken by Physician only
Do not swab necrotic or slough tissue
Culture swab of a wound should only be taken if clinical infection is suspected.
Or else the results are misleading
The details regarding the wound should be recorded on the request form- Document condition of
wound and evidence of infection including clinical symptoms – any antibiotic treatment the patient
on must be recorded, Clinical details will assist the microbiologist in making an accurate diagnosis.
Properly collected specimens will give optimal benefit in proper identification of the causative
organisms and appropriated Antibiotic suggestions.(Please log to CDC on Surgical site Infection)
Dr.T.V.Rao MD professor of Microbiology ( doctortvrao@gmail.com )