Introduction
Skin is a natural barrier against infection. However, even after taking numerous precautions and protocols to prevent infection, any surgery that causes skin rupture is thus directed to a disease. These infections are known as surgical site infections because they occur on the part of the body where the surgery is done. In surgery, the possibility of developing a surgical site infection is about one percent to three percent.
Surgical site infections are induced by bacteria entering the body through the incisions produced during surgery. They endanger millions of patients' lives every year and lead to the spread of antibiotic resistance. Eleven percent of patients undergoing surgery in low and middle-income countries are infected. In Africa, up to twenty percent of women who have a cesarean section contract a wound infection, compromising their health and capacity to watch for their babies.
What Are the Types of Surgical Site Infections?
A surgical site infection is a type of infection occurring within thirty days following surgery. There are three types of surgical site infections:
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Superficial Incisional Surgical Site Infections: This type of infection appears on the skin site where the incision was created.
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Deep Incisional Surgical Site Infections: This type of infection appears under the incision area in the muscle and the tissues enclosing the muscles.
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Organ or Space Surgical Site Infections: This type of infection can be in any area of the body different than the skin, muscle, and surrounding tissue involved in the surgery. This includes an organ or a space between organs.
What Are the Signs and Symptoms of Surgical Site Infections?
Surgical site infection symptoms include redness, delayed healing, fever, pain, tenderness, warmth, or swelling.
In addition, there are indications and symptoms for specific types of surgical site infection:
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Superficial incisional surgical site infections may create pus from the location of the wound. The pus samples may be cultivated in a culture to find the varieties of germs that induce the infection.
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Deep incisional surgical site infections create pus. The region of the wound is unobstructed, or a surgeon will open it again and discover the pus in the wound.
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An organ or space surgical site infection may indicate a discharge of pus from a drain positioned through the skin into a body space or organ. A collection of pus is known as an abscess; it is an encircled space of pus and disintegrating tissue wrapped by inflammation. An abscess may be noticed when the surgeon reopens the wound or by special X-ray studies.
What Are the Causes of Surgical Site Infections?
The most common cause of surgical site infections includes the bacteria Staphylococcus, Streptococcus, and Pseudomonas. Bacteria can infect a surgical wound through various forms of communication, such as from the touch of a contaminated caregiver or through a surgical instrument, through germs in the atmosphere, or through germs that are already on or in the body and then spread into the wound.
These other risk factors for surgical site infections are the duration of surgery exceeding two hours, a patient having different medical history or diseases, older age, overweight or obese patient, smoking, cancer patient, a weak immune system, diabetes, abdominal pain surgery, having emergency surgery. In addition, the risk of surgical site infections depends upon the type of wound.
These wounds can be classified as:
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Clean Wounds: This type of wound is not inflamed or infected and does not affect operating on an internal organ. These types are elective, not an emergency, and nontraumatic; wounds in this type are primarily closed, with no acute inflammation, and respiratory, gastrointestinal, biliary, and genitourinary tracts are not entered.
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Clean-Contaminated Wounds: These wounds, too, have no proof of infection at the time of surgery, but this wound involves operating on an internal organ. The urgent case that is otherwise clean; is the elective opening of the respiratory, gastrointestinal, biliary, or genitourinary tract with minimal spillage, not overlooking infected urine or bile.
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Contaminated Wounds: These wounds involve operating on an internal organ with a spilling of contents into the wound from the organ. These are non-purulent inflammation, and there is spillage from the gastrointestinal tract. In addition, there is entry into the biliary or genitourinary tract in the presence of infected bile or urine. Penetrating trauma more than four hours old and chronic open wounds to be wrapped.
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Dirty Wounds: These wounds have a known infection present during the surgery. They are purulent inflammation like an abscess, perforation of the respiratory, gastrointestinal, biliary, or genitourinary tract preoperatively, or penetrating trauma more than four hours old.
What Are the Treatment for Surgical Site Infections?
In most cases, antibiotics are used to treat the infection, and in some instances, surgical treatment is done to treat infections.
Antibiotic Prophylaxis-
- Prophylactic antibiotics should be efficacious against microorganisms predicted to induce infection. In addition, they should acquire adequate local tissue levels, cause minimal side effects, should be relatively inexpensive, and not be possible to choose contagious living things. The presence of microorganisms its quantity in the wound and the hospital atmosphere has an impact on the selection of antibiotics; the range targets the microorganisms understood to induce infection postoperatively. Generally, a first-generation Cephalosporin satisfies these measures and is considered sufficient prophylaxis for most treatments.
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A commonly administered drug is Cefazolin. For treatment of the alimentary tract, genitourinary tract, and hepatobiliary system, coverage should be further affected by gram-negative and anaerobic microorganisms. In some cases, Cefotetan or Cefoxitin is the right agent.
- For patients allergic to Cephalosporins, Vancomycin is an alternative for coverage of Staphylococcus. Aztreonam can be united with Clindamycin but not with Metronidazole. A quinolone, such as Ciprofloxacin, may be effective for the coverage of gram-negative organisms.
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Timing of administration is crucial. The drug should be administered within thirty minutes and within two hours of the time of incision. The foremost dose is delivered before the skin incision is executed.
- For more prolonged treatment procedures, drug administration is indicated at intervals of one or two times the drug's half-life. For example, they might be giving the same dose. This guarantees satisfactory tissue levels throughout the procedure. The period of a satisfactory tissue level of the antibiotic need not overextend the operative period. The administration period is advanced only in conditions such as gross contamination secondary to a ruptured viscus or severe trauma.
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The administration of antibiotics time varies for each patient but generally for at least one week.
Invasive Surgical Treatment-
- In some cases, the surgeon needs to do a surgical procedure to clean the wound; the procedure includes-They will open the wound by releasing the sutures, then doing tests of the pus to rule out if there is an infection and decide the type of antibiotics. Next, the eviction of infected tissue is done. Then irrigate the wound with salt water. They were followed by drainage of the pocket of pus. Finally, pack the wound with saline-soaked dressings.
Conclusion
Antibiotic administration decreases the occurrence of infection. Precaution is proposed in all clean-contaminated, contaminated, and dirty techniques. Timing of antibiotic administration is crucial for effectiveness. The first dose should always be delivered before the procedure, preferably within thirty minutes before the incision. Re-administration at one to two half-lives of the antibiotic is suggested for the period of the process. In general, postoperative administration is not advised. Antibiotic selection is affected by the organism most commonly causing wound infection in the specific procedure.
