infection in Surgeries

 Surgical site infections may occur following a breach in tissue surfaces and allow normal commensals and other

pathogens to initiate infection. They are a major cause of morbidity and mortality.

• Surgical site infections (SSI) comprise up to 20% of all healthcare associated infections and at least 5% of patients

undergoing surgery will develop an SSI as a result.

• In many cases the organisms are derived from the patient's own body.

• Measures that may increase the risk of SSI include:

o Shaving the wound using a razor (disposable clipper preferred)

o Using a non-iodine impregnated incise drape if one is deemed to be necessary

o Tissue hypoxia

o Delayed administration of prophylactic antibiotics in tourniquet surgery

Preoperatively

• Don't remove body hair routinely

• If hair needs removal, use electrical clippers with single use head (razors increase infection risk)

• Antibiotic prophylaxis if:

o Placement of prosthesis or valve

o Clean-contaminated surgery

o Contaminated surgery

• Use local formulary

• Aim to give single dose IV antibiotic on anaesthesia

• If a tourniquet is to be used, give prophylactic antibiotics earlier

Intraoperatively

• Prepare the skin with alcoholic chlorhexidine (Lowest incidence of SSI)

• Cover surgical site with dressing

• A recent meta-analysis has confirmed that administration of supplementary oxygen does not reduce the risk of

wound infection. In contrast to previous individual RCTs

• Wound edge protectors do not appear to confer benefit

Post operatively

Tissue viability advice for management of surgical wounds healing by secondary intention

Use of diathermy for skin incisions

In the NICE guidelines the use of diathermy for skin incisions is not advocated(3). Several randomised controlled trials

have been undertaken and demonstrated no increase in risk of SSI when diathermy is used.