Surgical

g
Site Infection
Hani Jokhdar,
Jokhdar, MD
Consultant
Cons
ltant of Communicable
Comm nicable Disease Cont
Control
ol

HASSI Introduction
SSI d
developed
l
d in
i 2% - 5% off the
th 27
million annual surgical procedure
It counts for approximately 11%
11% of
the total HAI
Classifying HAPneumo into VAP and
non--VAP would make the SSI second
non
to UTI as HAI
Hospital stay increases by 7.4 days

Surgical
g
Site Classification
Clean site;

1.

No inflammation
No involvement of pulmonary, GIT or
GU systems
Primarily closed and when drain is
i
involved
l d it is
i closed
l
d drainage
d i
Only blunt trauma are included in this
category

ContSS Classification
Clean--contaminated site;
Clean

2.

Pulmonary GIT or GU system

Pulmonary,
involvement, but under controlled
conditions
For example: biliary tract, appendix,
vagina,
vagina and oropharynx
No break in the technique

ContSSI Classification
Contaminated site;

3.

Fresh open injuries

Operation with major break in sterile
technique
Spillage from GI tract
Entry into the genitourinary tract with
i f t d urine
infected
i
Entry into the biliary tract with infected
bile
Non--p
Non
purulent inflamed surgical
g
site

ContSS Classification
Dirty or infected site;

4
4.

Old traumatic wounds with retained

devitalized tissues, foreign body or
fecal contamination
Surgical procedures involved bowl
perforation
Surgical procedures involved pus
drainage

Diagnosis of SSI
Clinicallyy diagnosed
g
when you
y see
pus at the site
CDC definition major criteria:

Purulent drainage from the site or the

drainage
drainage
Positive culture from the fluid of the
drainage
The
e su
surgeon
geo d
diagnose
ag ose infection
ect o
SS requires rere-opening

Microbes involved

Staphylococcus aureus

Coagulase-negative staphylococci
Coagulase Enterococci

Escherichia coli
Pseudomonas aeruginosa
Enterobacter spp.

Sources of pathogens

Endogenous sources

From the skin

S.

aureus

Coagulase
Coagulase--negative

staphylococci

From the pulmonary system, GIT or GUS

fl
flora
e.g. E.
E colili, Enterococci,
E t
i P.
P
aeruginosa etc.

Normal
N
l

ContSources of pathogens

Exogenous
g
sources

Personnel
Hands,
Hands

hair,
hair scalp,
scalp nose and mouth

Environment
Contaminated

dressings
Surfaces

solutions,
solutions antiseptics or

Air
Ventilation
V til ti

system
t
Positive pressure

Risk Factors
Surgical site classification
Prolonged preoperative stay
Preoperative shaving
Length of the operation
Surgical technique
Abdominal drains
Host factors

Prevention of SSI

Preoperative measures
Preoperative stay
Host factors
Preoperative
P
ti shower
h
Hair removal
Preoperative antibiotics

ContPrevention of SSI

Intraoperative measures

Preparation of the incisional site

Surgical scrub
Barrier devices
Masks
Caps
Gowns and drapes
p
Shoe cover
Reduction
educt o o
of a
air-bo
airborne
e co
contamination
ta
at o in tthe
eO
OR
Operative technique