With an associated cost of $3.5 billion to $10 billion spent annually on surgical site infections (SSIs) and complications in the United States,¹ it is important to know how to assess for surgical wound complications. There is a difference between the normal cascade response and a brewing infection. Symptoms of infection are often the first clue that there is more occurring in the wound than meets the eye.

Definition of a Surgical Site Infection

Assessing and monitoring for SSIs begin with knowing the definition of an SSI. The criteria for a superficial SSI include surgery in the last 30 days and involve the skin or subcutaneous tissue of the incision site, plus at least one of the following²:

• Superficial incisions that have purulent drainage
• The presence of organisms in an aseptically obtained culture of tissue or fluid obtained from the superficial incision
• The presence of one or more of the following symptoms of infection: pain or tenderness around the incision site, localized swelling, redness, or heat
• The diagnosis of a superficial incisional SSI by the surgeon or attending physician

Additionally, the surgical site may have delayed healing, and there may be purulent drainage.³ Anther cause for concern is a feeling of general malaise that does not go away or worsens. Nausea and vomiting can also be tell-tale signs of infection. Patients should be advised to see a clinician immediately if the surgical site begins to pull apart.

Surgical Site Infection Prevention Strategies

Clinical Leadership and Infection Control lists five simple steps to stop SSIs. Some of these basic steps are critical in eliminating SSIs. Basic hand hygiene following the World Health Organization guidelines is paramount but is also one of the greatest areas of non-compliance inside hospitals or surgery centers.⁴ If surfaces and equipment are not wiped down thoroughly between cases, they can become a breeding ground for bacteria and a prime spot to introduce bacteria through contaminated instruments.

Tracking data on infection rates also helps determine areas of improvement. Some other key points to preventing SSIs are to keep hands or other objects away from the incision. Pay attention to surgeons’ orders; if they ordered that the dressing not be changed for so many days, follow the order and do not change the dressing sooner. Patient education is also a vital part of preventing SSIs. Make sure to advise patients on proper surgical site management methods. Remind them not to soak in a bathtub or to take a shower until their surgeon clears the activity.

Monitoring for Surgical Site Infection

Preventing further complications of SSIs includes monitoring for infections to begin with. Make sure patients know what symptoms to watch for; if they start having symptoms of infection, they should notify the surgeon right away. Tell patients to watch for the following²:

• The surgical site starts pulling.
• Fatigue and malaise; this can be difficult for postsurgical patients to detect because they are still recovering from anesthesia, and the body is healing from the actual surgery itself. However, tell patients that if the fatigue is not getting better and the malaise is not resolving, this can also be a symptom of an SSI.
• Abnormal warmth and some pain or discomfort occur.
• Unusual odor comes from the surgical site, particularly odor that is foul smelling.

Conclusion

Make sure to talk over concerns and symptoms with the patient before surgery if possible. If not, try to provide a handout or educational sheet covering the symptoms to watch for and a detailed list of things to do and not do after surgery. Written instructions are helpful, especially after the surgery, when the patient may be groggy or still under the influences of anesthesia, when it can be difficult to remember all the instructions. If there is a family caregiver available, provide instruction and handouts to them as well.

References

1. Loyola University Health System. Surgical site infections are the most common and costly of hospital infections: guidelines for preventing surgical site infections are updated. ScienceDaily, January 19, 2017. https://www.sciencedaily.com/releases/2017/01/170119161551.htm. Accessed August 22, 2019.

2. Centers for Disease Control and Prevention (CDC). Surgical site infection (SSI). Atlanta, GA: CDC; 2010. https://www.cdc.gov/hai/ssi/ssi.html. Accessed August 22, 2019.

3. Johns Hopkins Medicine. Surgical site infections. Baltimore, MD: Johns Hopkins Medicine; 2019. https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical…. Accessed August 22, 2019.

4. Clinical Leadership and Infection Control. 5 simple ways to prevent surgical site infections in surgery centers. Chicago, IL: Becker’s Healthcare; 2011. https://www.beckersasc.com/asc-quality-infection-control/5-simple-ways-…. Accessed August 22, 2019.