Surgical Site Infection

What is surgical site infection?

Surgical site infection (SSI) is an infection that happens after surgery in the part of the body where you had the surgery. You can have the infection in:

• the incision (cut) made in your body when you had the surgery
• the body cavity where the surgery occurred, like the chest or the belly
• the organ operated on, or a nearby organ.

SSI is an important concern because:

• It causes more pain and discomfort as you recover from surgery.
• It can cause serious, sometimes fatal illness.
• You may need to stay at the hospital longer.
• It will take you longer to recover from the surgery.
• You may need more surgery to treat the infection.
• It increases medical expenses.

How does it occur?

Surgical site infection can happen in several ways. You have a greater risk of SSI if:

• You are a smoker and did not quit at least 30 days before surgery.
• You have another serious medical condition.
• You have diabetes and do not have good control of your blood sugar.
• Just before surgery you shaved the area where your skin was going to be cut. (Shaving with a razor can irritate your skin and make it easier to develop an infection.)
• You did not prepare for surgery as instructed by your healthcare provider. For example, if you had colon surgery, you did not clean out your bowel the day before surgery.
• You did not shower with antibacterial soap the night before your surgery.

SSI can also happen if doctors, nurses, and other healthcare providers skip important steps, such as:

• cleaning their hands and arms up to their elbows with an antiseptic agent just before the surgery
• properly cleaning your skin before surgery
• giving antibiotics at the right time before surgery
• using the right method for removing hair near the incision site
• keeping the operating room, personnel, and all equipment sterile.

SSI can also start after surgery if:

• The surgical wound gets bacteria in it when your healthcare provider examines or cares for it.
• The wound is not cared for properly.
• Doctors, nurses, and other healthcare providers do not clean their hands well before and after caring for each patient.
• The place where you have an IV is not carefully checked or changed, if needed, to prevent infection.

The infection may start in the hospital or it may not start until several days after you have gone home. The less time you stay at the hospital, the lower your risk of a surgical site infection.

Over the past few decades some bacteria have become resistant to many antibiotics. This means that the antibiotics no longer kill the bacteria. These infections are very hard to treat. Some bacteria are resistant to all known antibiotics. The infection can become life threatening. This is why all staff, patients, and visitors must follow all rules for clean, antiseptic care.

What are the symptoms?

Some of the symptoms are:

• redness and pain around the area where you had surgery
• drainage of cloudy fluid from your surgical wound
• fever.

How is it diagnosed?

Your healthcare provider will examine the surgical site, looking for redness, swelling, tenderness, and drainage of pus. Your temperature readings will be reviewed. You may have blood tests to look for signs of infection. When possible, fluid will be taken from the wound to check for bacteria. If the lab finds bacteria in fluid from the wound, the fluid can also be tested to see which antibiotics will be best for treatment of the infection.

If the surgical wound infection is inside your body, you may need special X-ray or ultrasound scans to look for a collection of pus in your abdomen, chest, or pelvis.

How is it treated?

Treatment depends on the situation. The infection may be treated by draining infected material from the body. The draining may be done at the hospital or in the surgeon’s office. If the infection happens after you leave the hospital, you may need to go back to the hospital.

You may be given antibiotics after the draining. Antibiotics may be given in the hospital or at home with the help of a visiting nurse or home health service.

In some cases you may need more surgery to treat the infection.

How can I help prevent SSI?

You can help prevent SSI by doing what you can to be as healthy as possible before your surgery. For example:

• If you smoke, you need to quit at least 30 days before surgery.
• If you have diabetes, you need to keep good control of your blood sugar.

Make sure you understand and follow preoperative instructions exactly as they were given to you. Tell your surgeon if you have any infections—like bladder infections or bronchitis--just before surgery is scheduled. Also tell your surgeon about any antibiotics you are taking. Be sure to talk to your surgeon about the risk of infection and how to prevent it. Everyone giving you care must follow all of the proper procedures for prevention of infection before, during, and after the surgery.

After your surgery:

• Make sure that your healthcare providers clean their hands before examining you, either with soap and water or an alcohol-based hand rub.
• Family and friends who visit you should not touch the surgical wound or dressings.
• Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, ask them to clean their hands.

If you have any questions, be sure to ask your healthcare provider.

When should I call my healthcare provider?

• Call your healthcare provider right away if:
  • The area around your wound is getting redder or more painful.
  • The wound area is very warm to touch.
  • You have blood, pus, or other fluid coming from your wound area.
  • You have a fever of 101.5° F (38.6° C) or higher.
  • You have chills, nausea, vomiting, or muscle aches.