Surgical site infections

SSIs

Specific risk factors - patient factors, environmental factors, treatment factors

• • Ascites for abdo surgery
  • PVD for lower extremity surgery
  • Skin disease in area of infection
  • Inadequate disinfection
  • Drains
  • Emergency procedure
  • Inadequate antibiotic prophylaxis
  • Prolonged operative time
  • Plus all the above general risks

Treatment

• 1. Open and examine suspicious portion of incision
     1. If confined to skin and superficial underlying subcutaneous tissue, may just need to open incision and provide local wound care
  2. Antibiotics for superficial incisional SSIs only if erythema extends beyond wound margin, or systemic signs of infection
  3. Deeper SSIs may require formal surgical exploration and debridement
  4. Consider SSI for delayed/non-healing wounds

Prophylaxis

• • Within 60 minutes before incision
  • Continue for no longer than 24 hours
  • Should be narrow-spectrum against specific organisms
    • Generally first-gen cephalosporin, unless either allergy (clindamycin) or anaerobic cover required (add metronidazole) or area-specific MRSA SSI rate is >20%
    • Redose cefazolin every 3-4 hours
  • Think about what they are actually FOR - they are for protecting the incision - and hence need to be active in blood while the incision is open - don't help protect against other infections
  • Specific situations
    • Elective lap chole - not unless high-risk features are present - age > 70, diabetes, or recently instrumented biliary tract
    • Elective colon surgery - clean-contaminated - yes give, but benefit to pre-op oral abx is controversial and evolving - may decrease risk of some infections, but also predisposes to C dif etc
    • Clean surgery - e.g. breast, hernia - minimal benefit