Prevention and Control of Surgical Site Infection

Introduction

Postoperative surgical site infection (SSI) is a rather common but an undesirable
complication of surgery.
It increases postoperative
morbidity and may sometimes lead to
mortality.
Efforts therefore need to be made to prevent it.
Prevention requires a good appreciation of the risk stratification according to type of surgical wound as well as the indications for the utilization of antibiotic prophylaxis.

Class of Surgical Wounds and Risk of SSI

Evidence Based Indications for Antibiotics Prophylaxis

Prophylactic antibiotics for prevention of SSI

Objective of antibiotic prophylaxis

  • To prevent postoperative infection in susceptible patients

Principles of antibiotic prophylaxis

  • Should be used only where there is a high risk of bacterial contamination
  • Intravenous route is preferred to achieve optimum effect
  • Should be given not >2 hours before surgical incision.
    • Many surgeons prefer to give at the time of induction of anaesthesia
  • Should be repeated intraoperatively if the surgery lasts for >3 hours
  • Not more than 2 – 3 doses (not longer than 24 hours) should be given after surgery
  • Antibiotics should be reinstituted if
    infection occurs bacteria in the part of the body
  • Broad spectrum antibiotics are preferred

Choice of antibiotics

  • Should depend on the known prevalent bacteria in the part of the body
  • Combination of antibiotics (with synergistic actions) is preferred to a single antibiotic
  • Should be used only when scientific evidence shows benefit

Indications for antibiotic prophylaxis

  1. Clean-contaminated and contaminated surgical wounds
  2. Patients with increased risk of infection: e.g. Immunosuppresion, diabetes mellitus, severe malnutrition, patients on steroids,
    patients on cytotoxic chemotherapy
  3. When prosthesis or implants are used
  4. To prevent infective endocarditis in patients with valvular heart disease or prostethic heart valves
  5. Patients with peripheral vascular disease undergoing surgery on that limb

Complications

  • Antibiotic misuse
  • Antibiotic resistance
  • Side effects of antibiotics (e.g. pseudomembranous colitis)
  • False sense of surgical security
  • Antibiotic prophylaxis should be effective and efficient