Management of post operative wound infection

MANAGEMENT OF POST
OPERATIVE WOUND INFECTION
(SURGICAL SITE INFECTION)
DR BASHIR YUNUS
20/11/14
bbinyunus2002@gmail.com 1 11/23/2014

 INTRODUCTION
 DEFINITION
 EPIDIMIOLOGY
 CLASSIFICATION
 PATHOGENESIS
 RISK FACTORS
 MICROBIOLOGY
 MANAGEMENT
 HISTORY
 PHYSICAL EXAMINATION
 INVESTIGATION
 TREATMENT
 PREVENTION
 CONCLUSION
 REFERENCES
OUTLINE

INTRODUCTION
 It is defined as infection present in any location along
the surgical tract after a surgical procedure within
30days of procedure or up to 1 year after a procedure
that has involved an implant.

INTRODUCTION
 Incidence vary from center to center.
 About 2-5% develop SSI in US accounting for about
300,000-500,000 patient per annum
 2nd most common type of Hospital Associated
infection.

INTRODUCTION
 CLASSIFICATION
 INCISIONAL
 Superficial (skin and subcutaneous )
 Deep (fascia and muscle)
 ORGAN/SPACE
 Involves any part of anatomy in organs and spaces other
than the incision which was opened or manipulated during
operation.

 CRITERIA
INTRODUCTION
 The above classification, each class is accompanied by at
least one of the following;
 Purulent discharge with or without laboratory
confirmation.
 Organism isolated from aseptically obtained culture
 At least one of the signs of inflammation
 Spontaneous wound dehiscence or delibrate opening by
the attending surgeon
 Diagnosis by the attending surgeon

INTRODUCTION
 RISK FACTORS
 GENERAL/ PATIENT FACTORS
 LOCAL FACTORS
 MICROBIAL FACTORS

 PATIENT FACTORS
 Age; elderly
 malnutrition
 Obesity
 DM
 Malignancy
 Prolonged steroid use
 Immunosuppressive diseases
 Anaemia
 Chronic inflammatory diseases

 LOCAL FACTORS
 Poor skin preparation
 Bridge of asepsis
 Contaminated instrument
 Prolong procedure(>2hrs)
 Poor surgical technique
 Operation on an infected organ: TIP, perforated appendicitis
 Foreign body
 Local tissue necrosis

 MICROBIAL FACTOR
 Virulence
 Bacterial resistance
 Dose of inoculum
 Pre-existing remote body site infection

MICRO-ORGANISMS
 Depends on the type of surgical procedure
 Clean : staph aureus (commonest)
 Exogenous source
 Skin flora
 Clean-contaminated, contaminated and dirty wound :
polymicrobial- anaerobes and aerobes
 E. coli
 Proteus
 Psedomonas
 bacteroides

 History
MANAGEMENT
 Pain, fever, discharge usually about 5th day post
operatively (5-7days)
 However, infection can be seen within 48hours(within 6-
8hrs) with organisms such as clostridium, bacteriodes, β-
hemolytic streptococcus and coliforms.
 History of risk factors as mentioned,co-morbidities.

MANAGEMENT
 Physical examination
 GPE
 Wasted
 Obese
 febrile
 Anaemic
 Dehydrated
 Pedal oedema

 Systemic
MANAGEMENT
 Systemic involvement- septicemia
 Pre-existing remote infection
 LOCAL
 Oedema
 Hyperamia
 Discharge
 Gapping wound edges
 tenderness

INVESTIGATION
 WOUND SWAB MCS
 WOUND BIOPSY
 FBC- leukocytosis, or leukopenia
 U/Ecr – hyponatremia in necrotising fasciitis
 USS- intra abdominal uss
 CTSCAN

Treatment
 Sutures in the infected part are removed for free drainage
of pus, expressed
 Wound swab is taken for MCS (other investigations are
requested base on the assessment of the attending surgeon)
FBC, U/E, USS, serum protein, wound biopsy-mcs
 Placed on broad spectrum antibiotics pending the result of
mcs
 Wound dressing(frequency depends on degree of
infection) and debridement of necrotic tissues.
 Correction of anaemia if present other derangements

PREVENTION
 It is better prevented than treated
 Prevention starts pre-operatively, intra and post-operatively

PREVENTION
 PRE-OPERATIVE
 Short pre-operative hospital stay
 Pre-op antiseptic shower
 Pre-op hair removal
 Pre-op bowel preparation
 Pre-op antibiotics
 Tight glucose control
 Optimize nutrition
 Stop smoking

PREVENTION
 INTRA-OPERATIVE
 Strict asepsis
 Skin preparation
 Gowning and draping
 Good surgical technique
 Dead space
 Appropriate sutures
 Debridement
 Approximate not strangulate
 Justify use of drain
 Delay primary closure when indicated
 Supplemental O₂, adequte fluid resuscitation,

PREVENTION
 POST-OPERATIVE
 Protect wound for 1st 48hrs then inspect, however if
dressing is soaked, change dressing.
 Early enteral nutrition
 Tight glucose control
 Surveillance programme

COMPLICATIONS
 Abscess
 Septicemia
 Sinus
 Synergistic gangrene
 Wound dehiscence
 Weak and ugly scar

CONCLUSION
 SSI is a common preventable post operative
complication which prolong hospital stay, hence cost
medical care as well as other complications.
 Risk factors should taken into consideration for
appropriate prevention and prompt treatment went
it occur.

REFERENCES
 E.A. Badoe, E.Q. Arcampompong, J.T Rocha; “Principles and Practice of
surgery including pathology in the tropics”. 4th edition, Assembly of God
Literature Center ltd 237-238
 F Charles et tal “schwart’s principles of surgery” tenth edition, Mc
Graw Hill Education.
 www.wikipedia.com
 www.slideshare.net

Management of post operative wound infection

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