Question

describe a minimum of five (5) interventions to prevent surgical site infections.

Answer 1

INTERVENTIONS TO PREVENT SURGICAL SITE INFECTIONS

A Surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. SSI can be defined as : “an infections occurring within 30 days after the operation and only involving the skin and subcutaneous tissue of the incision”.

Surgical site infection (SSI) is vary from 1% to 5% in the month following surgery due to the large number of surgical procedures conducted annually. Many interventions are used with the aim of reducing the risk of SSI in people undergoing surgery. These interventions can be broadly delivered at three stages: Preoperatively, Intraoperatively and Postoperatively.

Preventive Measures

Pre-Operative Phase

Give prophylactic antibiotics if indicated (clean surgery involving a prosthesis, clean-contaminated surgery, or contaminated surgery)

• Do not remove hair routinely – if necessary, do this immediately prior to surgery with an electric clipper
• Patient advice – shower prior to surgery, encourage weight loss, optimised nutrition (to promote wound healing), good diabetic control, and smoking cessation

Intraoperative Phase

• Prepare the skin at the surgical site immediately before the incision using an antiseptic preparation (povidone-iodine or chlorhexidine are most suitable)
• Change gloves or gowns if contaminated
• Use an appropriate interactive dressing at the end of the operation to cover all surgical incisions

Post-Operative Phase

• Monitor wounds closely – the use of see-through dressings* will limit the number of dressing changes, thus minimising the chance for bacterial contamination
• Ensure that wounds in difficult areas such as skin creases and underneath skin folds (such as groin) are closely observed
• Patients may require pads to separate the wound from overlying skin or be bed bound to remove pressure on a wound
• Refer to a tissue viability nurse for advice on appropriate dressings for the management of surgical wounds that are healing by secondary intention

Topical antibiotics are used in some cases post-operatively as well; a meta-analysis has shown that topical antibiotics probably do prevent SSI rates when compared with no topical antibiotic or antiseptic therapy

Key Points > Surgical site infections are a leading cause of in hospital morbidity, rates dependent on the type of surgery performed > Often appearing 5-7 days post-operatively, symptoms include spreading erythema, localised pain, pus/discharge from the wound, or a persistent pyrexia > Primary prevention is the optimal way in reducing surgical site infections, with several evidence-based interventions possible > Any case of surgical site infection should be regularly monitored, with any clips or sutures removed where feasible, any pus present is suitably drained, and empirical antibiotics prescribed

Conclusion

In spite of the use of prophylactic antibiotics, SSIs are still a real risk of surgery and represent a substantial burden of disease for both patients and healthcare services in terms of morbidity, mortality and economic cost.