Reducing surgical site infections in gynaecological surgery

Tagged surgery; Posted 8 years ago by Andreas Obermair

Surgical site infections (SSIs) are infections that occur in the wound made from a surgical procedure. SSIs can occur within 30 days after surgery in the part of the body where the surgery took place. SSIs are associated with increased morbidity, prolonged hospital stay or readmission, and increased health-care costs. SSIs occur in approximately 2% to 5% of all patients undergoing gynaecological surgery.

SSIs frequently only affect the superficial tissues (near the skin surface), but some more serious infections can affect the deeper tissues. The Center for Disease Control and Prevention describe three levels of SSI:

• Superficial incisional, affecting the skin and subcutaneous tissue. Symptoms include redness, pain, heat or swelling at the site of the incision or by the drainage of pus.
• Deep incisional, affecting the fascial and muscle layers. Symptoms include the presence of pus or an abscess (collection of pus), fever with tenderness of the wound, or a separation of the edges of the incision exposing the deeper tissues.
• Organ or space infection, which can be in any area or organ of the body other than skin, muscle, and surrounding tissue that was involved in the surgery. These infections may be indicated by the drainage of pus or the formation of an abscess. An abscess may be seen when the surgeon reopens the wound or by X-ray.

What causes a SSI?

Doctors and hospitals have many precautions and hygiene protocols to prevent infection. However, any surgery can lead to an infection. Germs can infect a surgical wound by people touching the wound, through germs in the air, or through germs that are already on or in your body. Many SSIs are caused by the patient's own bacterial flora on the skin.

Diagnosis and treatment of a SSI

Cellulitis is a common bacterial infection of the skin and subcutaneous tissues (just under the skin) that can occur at the site of the wound. Cellulitis is a superficial SSI, that can cause redness, pain, heat or swelling at the site of incision.

Diagnosis of cellulitis is a wound swab. A swab is taken from the affected skin and sent to the laboratory for testing. Antibiotics are used to treat the infection. In most cases, oral antibiotics are adequate, but in the severely ill person, readmission to hospital may be necessary. Intravenous antibiotics may be needed to control and prevent further spread of the infection. Most people respond to treatment in two to three days.

As with most medical conditions, early treatment is better. Delayed treatment could potentially lead to sepsis in serious cases.

What increases a patients SSI risk?

Aspects including type of surgery, age, comorbid conditions and patient factors increase the risk of SSI. Patient factors include being overweight, smoking, malnutrition, diabetes, steroid use, and immunosuppression.

Also, avoid shaving in the skin area that the surgeon is planning to operate. A review compared hair removal vs no hair removal and found no statistically significant difference in SSI rates. There was a greater risk of SSIs when shaving compared to clipping hair. There was no difference between hair removal the day before surgery or on the day of surgery.

How do doctors and hospitals reduce the risk of SSIs?

For a hysterectomy, preoperative antibiotic prophylaxis is the current standard of care. Antibiotics must be given at induction of anaesthesia (before the actual operation).

Several studies have shown that patients undergoing laparoscopic hysterectomies experience about a 50% reduction in SSI incidence and a shorter hospital stay compared with those undergoing open abdominal hysterectomies. With the recent results from the LACE trial, a laparoscopic hysterectomy, rather than open, abdominal can reduce the number of patients developing severe surgical complications, reduce hospital stay time and health care expenditure.

How do patients prevent SSIs after leaving the hospital?

Your nurse will explain how to care for your wound after leaving hospital to reduce any risk of SSIs. Always clean your hands before and after caring for your wound. Clean water is good for the surgical wound and does not cause harm. I recommend NOT using soaps or creams into the wound as this could cause an infection. You may use creams again once the wound has healed completely.

If the wound site becomes red and sore, hot or, is draining fluid, or you have a fever please arrange for a wound swab and oral antibiotics or contact our rooms or the hospital’s Emergency Centre. Most surgical site infections can be treated with antibiotics. Sometimes additional surgery or procedures may be required to treat the SSI.

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