Treatment for Surgical Site Infections

Introduction

Skin provides a natural defense against infection in the human body. Any surgery or trauma resulting in a break in the continuity of the skin can induce an infection. The infections are known as "surgical site infections" (SSI) because they develop in the area of the body where the surgery is performed. The person's risk is one to three percent after surgery.

What Are the Types of Surgical Site Infections?

Usually, within thirty days of surgery, an SSI can develop. There are three categories of surgical site infections:

• SSI for Superficial Incision - Only the incised skin area becomes infected.

• Deep SSI Incision - The muscle and tissues around the incision become infected.

• Space or Organ SSI - This infection can occur anywhere in the body besides the skin, muscles, and surrounding tissue involved in the surgery. This type of SSI includes a bodily organ or the area between organs.

What Are the Signs and Symptoms of Surgical Site Infections?

The signs and symptoms of SSI include the following:

• Any SSI may result in swelling, fever, pain, soreness, redness, or delayed healing.

• A superficial SSI may produce pus from the wound site. Pus sample cultures can help identify the specific microorganisms responsible for the infection.

• SSIs with deep incisions may also ooze pus. The wound site may heal on its own, or a surgeon can perform a surgical reopening, visualize the pus site inside the wound and treat it.

• Pus may leak from a drain inserted through the skin into an organ or body space. The surgeon reopens the wound or uses specialized X-ray imaging to identify and visualize the abscess.

An enclosed region of pus and decomposed tissue surrounded by inflammation is called an abscess.

What Are the Causes and Associated Risk Factors for Surgical Site Infections?

Microbes cause infections after surgery. The bacteria Staphylococcus, Streptococcus, and Pseudomonas are among the most prevalent. Microbes can enter a surgical wound through contact, including touching a contaminated person or surgical tool or breathing in bacteria from the air. Other risk factors for SSI include the following:

• A surgical procedure that takes more than two hours.

• Patients with the co-existing systematic disease.

• Patients with advanced age.

• Excess weight.

• Smoking.

• Weak immune system.

• A diabetic person.

• Patient undergoing emergency surgery.

• Having an abdominal procedure.

• Patients with other debilitating diseases, such as AIDS (acquired immunodeficiency syndrome).

How to Prevent and Treat Surgical Site Infection?

Certain measures must be kept in mind to prevent and treat surgical site infection. These are divided into three parts as follows:

• Pre-operative phase is the time before surgery.

• The intraoperative phase is the time during surgery.

• The postoperative phase is the time after surgery.

How Is SSI in the Preoperative Phase Prevented?

• Preoperative Showering - Either the day before surgery or the day of surgery, a person should shower or give a patient a bed bath if they cannot do it on their own with soap.

• Nasal Decolonization - Before procedures, use nasal mupirocin (topical antibiotic) in combination with a chlorhexidine body wash. This combination works against Staphylococcus aureus (a microorganism that causes surgical site infection).

• Hair Removal - It is not recommended to use routine hair removal to lessen the risk of surgical site infection. On the day before the operation, if hair needs to be cut, utilize electric clippers with a single-use head because the danger of surgical site infection increases with using razors for hair removal.

• Patient Wear in the Operation Theater - Patients should wear specialized attire suitable for the procedure and the clinical setting. The clothes should enable easy access to the surgical site and locations. All clothes should be sterile.

• Employees Wear in the Operating Room - Employees without sterile clothes should not enter the room. All staff members should wear sterile clothes in the operation room, where procedures are performed.

• Removal of Jewelry and Artificial Nails - The surgical team should remove all jewelry, artificial nails, and nail polish before any procedures.

• Antibiotic Prophylaxis - A doctor prescribes antibiotics to the patients. A person should avoid antibacterial prophylaxis during simple, clean surgeries without prosthetics. A doctor should inform patients whether they will require antibiotic prophylaxis before surgery and whether they received antibiotics during the procedure.

How Can a Surgical Site Infection Be Prevented During the Intraoperative Period?

• Hand Decontamination - Before beginning the surgery, the operating team should wash their hands with an aqueous antiseptic surgical solution and use a single-use brush to clean their nails. Hands should be cleaned with an alcoholic hand massage or an antiseptic surgical solution before subsequent operations. Hands should be cleaned once more with an antiseptic surgical solution if they are dirty.

• Incise Drapes - Avoid using non-iodophor-impregnated incise drapes for surgery regularly, as they may increase the risk of an infection at the surgical site. Use an iodophor-impregnated drape if an incise drape is necessary unless the patient has an iodine allergy.

• Sterile Gowns - The surgical team should be dressed in sterile gowns while performing the procedure. When glove perforation is dangerous, wearing two pairs of sterile gloves is recommended.

• Antiseptic Skin Preparation - Apply an antiseptic preparation to the surgical site skin before making an incision. Be careful of the dangers associated with using skin antiseptics on infants, particularly the possibility of severe chemical burns when using chlorhexidine on preterm infants (babies born before 37 weeks of gestation).

• Avoid Diathermy - A diathermy is a machine that makes an incision with the help of heat. Avoid using diathermy on an incision to lessen the danger of an infection at the surgical site.

• Maintain Homeostasis of Patient - Maintain the patient's temperature during surgery. The oxygenation level should be optimal. Give the patient enough oxygen, particularly during significant surgery and healing, to maintain adequate oxygen saturation. During surgery, keep the perfusion (oxygen supply to different organs) adequate. To lower the risk of surgical site infection, avoid insulin in people who do not have diabetes to optimize blood glucose levels after surgery.

• Intracavity Lavage and Wound Irrigation - A doctor should not utilize wound irrigation to lower the risk of surgical site infection. Intracavity lavage also should not be used to lower the risk of surgical site infection.

• Closure Techniques - To lower the risk of surgical site infection, consider using antibacterial triclosan-coated sutures, especially for pediatric (children) surgery. To lower the risk of superficial wound dehiscence (rupture of the wound) following a cesarean section, consider using sutures rather than staples to close the skin.

• Dressings for Wounds - A doctor should cover surgical incisions with an appropriate dressing at the end of the procedure.

How Should a Postoperative Surgical Site Infection Be Treated?

• When replacing or removing surgical dressings, the medically-qualified person should use an aseptic solution and follow the no-touch method (minimal touch to wound). Sterile saline should clean the wound up to 48 hours following surgery. Inform patients that showering is safe after 48 hours of surgery. If the surgical wound has separated, tap water should be used for wound washing after 48 hours.

• Antibiotics are usually effective in treating SSIs. To treat SSI, additional surgery or procedures are needed occasionally.

• Make sure everyone washes their hands before and after entering the patient room while the patient is recovering.

• The doctor should be asked for advice on what can be done to lower the risk of a surgical site infection when undergoing surgery.

• In particular, if a person has diabetes or other chronic condition (long-term illness), they should stop smoking before surgery and provide the proper medical history to the surgical team.

• The individual or family should not touch the wound or surgical site.

• The patients should follow the doctor's post-operative wound care instructions carefully.

• A person should immediately consult a doctor if they experience any signs or symptoms of a surgical site infection, such as fever, pus, redness, heat, pain, or tenderness near the wound.

Conclusion

Surgical site infections (SSIs) develop in the surgical wound following invasive surgery. These are the major causes of healthcare-associated infections (HCAIs). Many of these infections happen after the patient is discharged from the hospital. Other clinical effects of SSIs include unappealing scars, chronic discomfort, itching, movement restrictions, particularly when they cover joints, and a significant negative impact on emotional well-being. Because of SSI, a patient's stay in the hospital can lengthen, increasing the cost of medical care. Additional costs include re-operations, nursing care, interventions, and drug treatment. SSIs also lower treatment quality. To avoid surgical site infections, the patient and the surgical team must adhere to all guidelines.