Surgical Site Infection

Created: June 28, 2021

Last Updated: November 18, 2023

Contributor(s):

Heather Kooiker

Mike Modrow PA-C

ERAS Cardiac Collaborative Network

Editor(s):

Cheryl Crisafi MSN RN CNL

Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC

Gina McConnell RN BSN CCRN

Shannon Crotwell RN BSN CCRN

Alexander Gregory MD FRCPC

Sponsor

Baxter

Summary

Surgical site infections post-cardiac surgery have multi-faceted impacts on both patients and the healthcare system. For patients, they entail physical, emotional, and financial hardships. The healthcare system faces increased costs, resource utilization, and potential reputational damage. Preventive measures, early detection, and timely management of SSIs are essential to mitigate these adverse effects and ensure optimal patient outcomes and system efficiency.

A Surgical Site Infection (SSI) in cardiac surgery refers to an infection that occurs at or near the surgical incision within 30 days of the operation, or within one year if an implant is placed during the surgery. These infections can affect either the incision and skin layer or the deeper tissue layers and organs involved in the surgery.

SSI’s have several negative impacts on post-operative recovery from the patient’s perspective:

Increased Morbidity:

  • SSIs lead to worsening health conditions, with potential development of severe complications.

Prolonged Recovery:

  • The healing process after surgery is extended, leading to delayed wound healing and longer recovery time.

Additional Treatments:

  • Patients often require additional treatments including antibiotics or even additional surgeries to manage the infection.

Psychological Stress:

  • Facing an infection post-surgery can induce anxiety, depression, and stress in patients.

Financial Burden:

  • Patients might incur extra expenses due to extended hospital stays, additional treatments, and follow-up visits.

Quality of Life:

  • The overall quality of life may be reduced due to pain, physical limitations, and ongoing medical treatments.

Additionally, SSI’s will also have adverse effects on the overall healthcare system:

Antibiotic Resistance:

  • Increased use of antibiotics to treat SSIs can contribute to the growing issue of antibiotic resistance.

Bed Occupancy:

  • Extended hospital stays for patients with SSIs increase bed occupancy rates, reducing availability for other patients.

Staff Allocation:

  • More nursing and medical staff time is required to manage and care for patients with infections.

Increased Costs:

  • The healthcare system faces higher costs due to additional diagnostic tests, treatments, and extended hospital stays.

Reimbursement Challenges:

  • Hospitals might face challenges with insurance reimbursements due to complications and readmissions.

Several risk factors for SSI have been identified:

Patient-related:

  • Diabetes mellitus
  • Obesity
  • Immunosuppression
  • Advanced age
  • Malnutrition

Surgery-related:

  • Failure to properly administer antibiotic prophylaxis
  • Poor maintenance of normothermia
  • Inadequate sterilization or aseptic techniques
  • Prolonged operative time
  • Poor incision care
  • Hematoma or seroma formation

SSI reduction bundles can help reduce the risk for post-operative infection. Although the exact components may vary between institutions, a basic outline of items for consideration in a bundle includes:

  • Educating patients on the importance of hygiene and infection prevention pre-surgery.
  • Using antiseptic solutions for bathing before the surgery.
  • Application of topical antiseptics or antibiotics to eliminate carriage of Staphylococcus aureus.
  • Monitoring and controlling the blood sugar levels in diabetic patients.
  • Identify and correct nutritional deficiency.
  • Administering antibiotics before the incision is made, as well as continuing post-operatively for an appropriate duration.
  • Maintaining the patient's body temperature to optimize immune function.
  • Ensuring adequate oxygen supply to minimize the risk of infection.
  • Proper wound care and dressings to promote healing and reduce infection.
  • Monitoring for signs of infection and taking prompt action if detected.
  • Collecting data on infection rates and analyzing for continual improvement in practices.

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This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

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Educational Materials

IHIT: I Hate Infections Team
Mike Modrow from WakeMed reviews surgical site infections and how they can be reduced through a comprehensive multidisciplinary approach.
Normothermia: The New Norm
In this video Heather Kooiker reviews the importance and options for maintaining normothermia throughout the peri-operative period. [Sponsored]

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