Surgical Site Infections Role of Diagnostic Microbiology Dr.T.V.

Rao MD
A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material. It is coordinated efforts of Surgeons and Microbiologist to educate the staff and Doctors to the concerns associated with infection. To prevent surgical site infections, doctors, nurses and other healthcare providers will take several measures to ensure that the surgical site is as clean as possible, including: Cleaning their hands and arms up to the elbows with an antiseptic agent just before the surgery Wearing hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean Cleaning the skin at the surgery site with a special soap that kills germs In the present contest many of our patients are discharged as early as possible to get back to work and also the hospital costs are increasing, many patients come back to our outpatient departments to get the dressing changed, outpatient surgery centres, are one setting where there has been significant growth in recent years both in number and in the type and complexity of procedures performed. Ensuring patient safety in all settings is a priority for the Hospitals as a whole, and we should take our work scientifically to prevent several infections spread in dressing rooms. All healthcare facilities should take this as an opportunity to evaluate their current infection control policies and, more importantly, make sure their staff understands and follows them. It is the duty of the Seniors Nurses to educate the junior staff to attend the patients when they are changing the dressings with scientific spirit. What the Bacteriological culture means to Surgeons and Physicians 1 In Patients who undergo a surgical procedure if infected, An appropriate sample should be selected in line with your local clinical and diagnostic facilities. 2 The specimens should the collected with care and caution as per the demands of the Microbiology Department. 3 Training is provided to hospital staff to facilitate compliance with the surveillance protocol. Each hospital collects data prospectively on all eligible patients in a self-selected surgical category over a 3 month period. 4 The Bacteriological reporting carries the importance that it has to be supervised by Senior Microbiologists who have knowledge in Clinical Microbiology and analysis has shown that there is considerable heterogeneity in the trends between surgical categories. The factors underpinning these trends are likely to be related to patient and peri-operative factors. Although many patientrelated risk factors are non-modifiable there are several aspects in the peri-operative phase that can be optimised to minimise the risk of SSI to the patient. These include glucose control and compliance with guidelines on surgical antibiotic prophylaxis relating to the choice, frequency, dose and timing of the antimicrobial agents

Preparing to Collect the Swabs from WoundsThe person collecting specimens should decontaminate hands to reduce the risk of transfer of transient organisms on the healthcare workers hands to the patient. Apply gloves (remove dressing as appropriate) to protect the health care workers hands. The wound should be cleansed with sterile saline to irrigate any purulent debris (Stotts 2007) to achieve a clean culture site and to avoid obtaining a culture from the pus on the surface of the wound. Moisten the swab with sterile saline before taking sample. In dry wounds a moistened swab will attach bacteria more effectively. Always take a swab from a newly cleaned wound. Cleanse with normal saline or sterile water Take a swab by moving in a Z pattern over the wound and turning the swab at the same time Punch biopsy to be taken by Physician only Do not swab necrotic or slough tissue Culture swab of a wound should only be taken if clinical infection is suspected. Or else the results are misleading The details regarding the wound should be recorded on the request form- Document condition of wound and evidence of infection including clinical symptoms any antibiotic treatment the patient on must be recorded, Clinical details will assist the microbiologist in making an accurate diagnosis. Properly collected specimens will give optimal benefit in proper identification of the causative organisms and appropriated Antibiotic suggestions. (Please log to CDC on Surgical site Infection) Dr.T.V.Rao MD professor of Microbiology ( doctortvrao@gmail.com )