Post-Surgical Infection: Causes, Types, Symptoms, and Treatment

Introduction:

When an individual undergoes surgery and recovers, their life is safe, but it comes up with certain risks. The infection a person gains after surgery may slow down the recovery process. The skin is a protective layer that saves us from infection unless it is cut open. Surgery involves breaking the protective layer and paving the way for infectious organisms to invade.

What Are the Types of Post-surgical Infections?

Post-surgical infection is a serious health problem.

They can be classified as:

• Superficial Incisional Infection: It involves the skin and subcutaneous tissues and accounts for 50 % of post-surgical infections. A purulent discharge from the wound characterizes it.

• Deep Incisional Infections: These involve tissues situated deep under the skin, like muscles and fascia. The opening of the deep incision, abscess formation, and purulent discharge characterizes it.

• Organ Infection: It may involve the organ under the incised site. It is characterized by abscess formation, purulent discharge, and identification of the infectious organisms in the organ.

How Is a Wound Identified as a Surgical Site Infection?

The wound can be categorized as a surgical site infection if

• It occurs within 30 days after the surgery.

• It involves the skin, subcutaneous tissues, muscles, fascial planes, and organs.

• It involves purulent discharge and the isolation of infectious organisms from the site.

What Are the Signs and Symptoms of Post-surgical Infections?

The post-surgical infections can present signs of inflammation, such as redness, pain, warmth, and swelling, accompanied by delayed healing. The discharge of pus from the surgical wound characterizes all post-surgical infections. This sample can be sent for culture to identify the organism responsible for the infection. In the case of deep surgical infection, the wound may reopen by itself, or the surgeon may open the wound, which shows the discharge of pus. In the case of organ or space infection, pus can be identified through the drain placed over the skin extending into the organ. An abscess can be noticed by the surgeon when the wound is reopened or through X-rays.

What Are the Causes and Risk Factors of Post-surgical Infections?

The common causes of infections are bacteria such as Staphylococcus, Streptococcus, and Pseudomonas. The germs reach the wound when these bacteria contact the wound through a contaminated instrument or a caregiver.

The risk factors for post-surgical infection are:

• Surgery occurs for more than two hours.

• Individuals with medical conditions.

• Older adults.

• Overweight individuals.

• Smoking individuals.

• Individuals with cancer.

• Individuals with weakened immune systems.

• Individuals with diabetes.

• Individuals undergoing emergency surgery.

• Individuals undergoing abdominal surgery.

How Are Surgical Wounds Classified?

The severity of the risk also depends on the type of surgical wound.

The types of surgical wounds are:

• Clean Wounds: These wounds are apparent with no inflammation. They do not need surgery on the organ.

• Clean-Contaminated Wounds: In these wounds, there is no sign of infection during the surgery, but it requires organ operation.

• Contaminated Wounds: These wounds involve the operation of the organ characterized by the spilling of pus from the organ into the wound.

• Dirty Wounds: These wounds indicate the presence of an infection at the time of surgery itself.

How to Prevent Post-surgical Infections?

The prevention of the post-surgical approach depends on preoperative, intraoperative, and postoperative care.

Preoperative Care:-

• If already an infection is identified before the surgery, treat the infection and then proceed with the surgery.

• The blood glucose levels of diabetic patients should be at controlled levels before the operation.

• Individuals are instructed to quit tobacco 30 days before the operation.

• The area should be thoroughly cleaned before applying an antiseptic solution.

• The surgical team members should perform a surgical scrub using an effective antiseptic before the surgery.

• Surgeons should use a sterile glove before starting the procedure.

• Prophylactic antibiotics have to be administered priorly against common pathogens.

• Antimicrobial agents are administered intravenously to show a bactericidal action when incisions are made.

Intraoperative Care:-

• Positive pressure ventilation should be maintained in the operating room.

• Avoid using ultraviolet light in the operating room to prevent post-surgical infection.

• Limit the number of members in the operating room.

• When there is visible blood or body fluids contamination in the operating room, use a disinfectant to clean the areas.

• Use only sterilized instruments for surgery.

• Wear a surgical mask, cap, and gown to prevent contamination.

• Use intravascular devices under aseptic conditions.

• Use a closed suction drain if necessary.

Postoperative Care:-

• The surgically treated area has to be covered with a sterile dressing for 24 to 48 hours.

• Wash hands when the surgical area is touched.

• The individual treated and the family should be educated on caring for the wound after surgery.

How to Treat Post-surgical Infections?

Postoperatively acquired infections can be treated by administering the appropriate antibiotics based on the organism obtained in the culture. The surgical site has to be debrided earlier to resolve the infection. When the infection is too deep, the surgical wound must be reopened and treated in severe cases.

What Are the Complications of a Post-surgical Infection?

Post-surgical infections can lead to local and systemic complications. The local complications include cellulitis, non-healing wound, delayed healing, abscess formation, and osteomyelitis. The systemic complications include bacteremia causing the hematogeneous spread of the infection.

When to Seek Help?

Once the individual has reached home after the surgery, they should seek immediate help if they present with the following signs and symptoms.

• Signs of infection.

• Redness, warmth, pain, bleeding, swelling, and discharge from the surgical wound.

• Nausea or vomiting.

• Persistent pain that does not subside even under medication.

• Chest pain and difficulty breathing.

• Swollen legs and feet.

• Coughing up yellowish, bloody, or greenish sputum.

Conclusion:

Nearly one to four percent of individuals undergoing surgery are at risk of developing infections. These infections may hinder the surgical wound's healing, take a long time for the individual to recover, or even lead to severe complications. So it is good to follow the postoperative instructions properly and save the wound from getting infected.