Surveillance of surgical site infections

Surgical site infections arise from both endogenous and exogenous transmission, and several patien trelated and surgery related factors have been implicated as risk factors.The microbial sources of surgical site infections vary according to the type of surgery, and the most common microorganisms are S. aureus, coagulasenegative staph, Enterococcus spp., E.coli, P. aeruginosa, andEnterobacter spp. Active Surveillance of SSI is the key to observe the SSI so proper definitions of the SSI is needed that is divided SSI intro five sub types (basically three):

Surveillance of SSI

Surveillance of SSI

 

  • Superficial incisional (Primary & Secondary)
  • Deep Incisional (Primary & Secondary)
  • Organ and space

 

Superficial incisional SSI

Infection has to occur within 30 days after any operative procedure and involves only skin and subcutaneous tissue of the incision and patient has at least 1 of the following:

 

  1. Drainage from the incision
  2. Isolated organisms aseptically-obtained
  3. Incision culture of fluid or tissue .
  4. Incision that is deliberately opened  and is culture-positive or not cultured
  5. Diagnosis of incisional surgical Site Infection by the surgeon or attending physician

 

 

Patient has at least one of the following signs or symptoms of infection: Pain or tenderness; localized swelling; redness; heat.negative culture  does not accepting this criterion

 

There are two types of superficial SSIs:

 

  1. Superficial Incisional Primary (SIP) that is identified in the primary incision in a patient that has had an operation with one or more incisions (e.g., C-section incision or chest incision for CBGB)
  2. Superficial Incisional Secondary (SIS) that is identified in the secondary incision in a patient that has had an operation with more than one incision (e.g., donor site [leg] incision for CBGB)

 

Deep incisional SSI

 

Infection involves deep soft tissues of the incision (e.g., fascial and muscle layers) within 30 after surgical operation and will be extended for 90 days for the following operations:

Breast surgery

Cardiac surgery

CABG (chest and donor site )

CABG with chest incision only

Craniotomy

Spinal fusion

Open reduction of fracture

Herniorrhaphy

Hip prosthesis

Knee prosthesis

Pacemaker surgery

Peripheral vascular bypass surgery

Refusion of spine

Ventricular shunt

 

Patient has at one of the following:

 

  1. drainage from the deep site
  2. a deep incision that spontaneously dehisces or is deliberately opened by a surgeon and is culture-positive or not cultured and patient has at least one of the following signs or symptoms: fever (>38°C); localized pain . A negative culture not accepted in this criterion.
  3. Abscess or other infection evidence involving the incision is found on direct examination, during invasive procedure, or by histopathologic examination or imaging test.
  4. Surgeon or attending physician diagnosis of a deep incisional .

 

There are two specific types deep Surgical Site Infection:

  1. Deep Incisional Primary (DIP) that is identified in a primary incision in a patient that has had an operation with one or more incisions (e.g., C-section incision or chest incision for CBGB)
  2. Deep Incisional Secondary (DIS) that is identified in the secondary incision in a patient that has had an operation with more than one incision (e.g., donor site [leg] incision for CBGB)

 

Organ/Space SSI

 

Infection involves any part of the human body with exclusion of (skin , fascia, or muscle) within 30 after surgical operation and will be extended for 90 days (for the same operations mentioned in the secondary surgical site infection)and patient has at least 1 of the following:

 

  1. Drainage from organ/space
  2. Isolated organisms from an aseptically-obtained culture of fluid or tissue in the organ/space
  3. an abscess or other evidence of infection involving the organ/space that is found on examination, invasive procedure, or by histopathologic examination or imaging test
  4. surgeon or attending physician diagnosis of an organ/space SSI .

 

And meets at least one criterion for a specific organ/space infection:

 

Osteomyelitis

Joint or bursa

Breast abscess or mastitis

Other infections of the RT

Myocarditis or pericarditis

Mediastinitis

Disc space

Meningitis or ventriculitis

Ear, mastoid

Oral cavity (mouth, tongue, or gums)

Endometritis

Other infections of the male or female Genital tract

Endocarditis

Other infections of the urinary tract

Eye, other than conjunctivitis

Spinal abscess without meningitis

GI tract

Sinusitis

Hepatitis

Upper respiratory tract

Intraabdominal, not specified

elsewhere

Arterial or venous infection

Intracranial, brain abscess or dura

Vaginal cuff

 

Reference

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