Surgical wound infection

A wound is a break in the skin. Wounds are usually caused by cuts or scrapes.
Different kinds of wounds may be treated differently from one another, depending upon
how they happened and how serious they are.
Healing is a response to the injury that sets into motion a sequence of events.
With the exception of bone, all tissues heal with some scarring. The object of proper
care is to minimize the possibility of infection and scarring.

A surgical wound/site infection is defined by the following criteria:

Infection must occur within 30 days of the surgical operation. And at least one of
the following is present:
• Purulent discharge from the surgical site
• Purulent discharge from wound or drain placed in wound
• Organisms isolated from aseptically obtained wound culture
• Must be at least one of the signs and symptoms of infection – pain or
tenderness, localised swelling, or redness/heat.

Other signs of wound infection include:

• Delayed healing not previously anticipated.
• Discolouration of tissues both within and at the wound margins.
• Abnormal smell coming from wound site.
• Friable, bleeding granulation tissue despite appropriate care and management.
• Lymphangitis, a red line originating from the wound and leading to swollen tender
lymph glands draining the affected area.
Drainage
• Serous - Clear, watery plasma
• Purulent – Thick ; yellow, green, tan, or brown
• Sanguinous - Bright red (active bleeding)
• Serosanguinous - Pale, red, watery ; mixture of serous and sanguinous

What causes wound infections?

Wound infections are caused by the deposition and multiplication of microorganisms
in the surgical site of a susceptible host. There are a number of ways microorganisms
can get into wounds.
• Direct contact – transfer from surgical equipment or the hands of the surgeons
or nurses
• Airborne dispersal – surrounding air contaminated with micro-organisms that
deposit onto the wound
• Self-contamination – physical migration of the patient’s own endogenous flora
which are present on the skin, mucous membranes or gastrointestinal tract to the
surgical site.

Barriers to Healing
• Age
• Malnutrition
• Obesity
• Impaired Oxygenation
• Smoking
o Decreases functional Hgb in blood
o Interferes with release of O2 to tissues
• Drugs
• Diabetes
• Radiation
• Wound Stress
• Poor Care
What is the management of wound infections?
The goal of wound infection management is to prevent or minimize the risk of
infection.
Antibiotic prophylaxis is generally indicated for clean-contaminated and
contaminated wounds. Antibiotics for dirty wounds are part of the treatment because
infection is already established. When deciding on a prophylactic antibiotic consider the
following:
• Use an antibiotic based on likely bacteria to cause infection
• Antibiotic should have good tissue penetration to reach wound involved
• Timing and duration of antibiotic – it is important that therapeutic concentrations
are reached at time of the incision, throughout the surgical procedure and ideally
a few hours postoperatively.
Wound infections can complicate illness, cause anxiety, increase patient discomfort
and lead to death. It is estimated that surgical wound infections result in an increased
length of hospital stay by about 7-10 days. Hence the prevention and management of
wound infections has a major impact on both patient health and health economics.

Home Care
Scrapes and abrasions often do not require any more care than washing the area 4
times daily for the first 48 hours and keeping the area covered with a sterile bandage.
Deeper wounds and bites will require medical attention.
• Stop the bleeding: If bleeding will not stop, apply a clean bandage to the area
and press down on it for 10 minutes.
• Clean the wound: Water under pressure is the best way to clean a wound. Either
a briskly running faucet or a hand-held shower nozzle is the best way to wash a
wound. The wound should be washed for 10-15 minutes. Make sure you remove
all dirt and debris. Do not scrub deep wounds or bites, just wash them out.

Prevent Infected Wounds

Step 1
Wash your hands with soap and hot water before touching the wound.
Step 2
Immediately wash the wound with soap and warm water for at least five minutes
to remove dirt and bacteria. Antiseptic solution such as Povidone Iodine can be
used.
Step 3
Apply antibiotic ointment to the wound and the area around it.
Step 4
Carefully apply dressing in the affected area. The dressing should completely
cover the affected area without sticking to the wound.
Step 5
Wash the wound and change the dressing at least once every day or when the
dressing gets wet or soiled. You need to keep the wound clean and dry to
prevent infection and this can easily be done by promptly changing the dressing
when it needs it.