1. Surgical Infection
FY1 Rosalind Pool

2. Pathophysiology of Bacterial Infection
Presence of bacteria
Diminished host resistance
Skin barrier breached
Suitable environment
Warm
Wet
Food source e.g. carbohydrates, proteins

3. Surgical Site Infections
20% of all healthcare-associated infections
5% of patients undergoing surgery develop a surgical site infection
Significant effect on patient’s quality of life
Increased morbidity
Extend hospital stay

4. NICE Guideline 2008 Prevention and Treatment of Surgical Site Infection
Pre-operative
Intra-operative
Post-operative

5. Pre-operative Patient preparation: Hair removal
Wash on day before or day of surgery
Hair removal
Electric clippers with a single-use disposable head
Antibiotic prophylaxis:
Clean surgery involving a prosthesis or implant
Clean-contaminated surgery
Contaminated surgery
Dirty

6. Surgical wound classification
Clean: No contamination from GI, Respiratory or genitourinary tracts.
Inguinal hernia repair
Clean-contaminated: Minimal contamination from GI, Resp, GU tracts
Cholecystectomy, TURP
Contaminated: Significant contamination from GI, Resp, GU tracts
Elective hemicolectomy
Appendicectomy
Open traumatic wounds that are more than 12–24 hours old also fall into this category.
Dirty or infected: Infection present
Perforated appendicectomy
Bowel perforation

7. Intra-operative Operating personnel Skin prep
Wash hands
Sterile gowns and gloves
Skin prep
Chlorhexidine or povidone-iodine
Maintain patient homeostasis
Temperature
Oxygenation
Organ perfusion
Dressing
Cover surgical incision

8. Post-operative Dressing of wound Antibiotics Wound care
Aseptic non-touch technique for changing dressings
Only shower after 48 hours
Antibiotics
If infection suspected give antibiotics according to local guidelines
Wound care
Tissue viability nurse

9. Pyrexia
Mild raise is normal early post-op
Think 7 Cs

10. Remember these… Cannula Catheter Cut Central line Chest Clot
Collection