Surgical Site Infection

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KEY POINTS

• Surgical site infection is an infection that happens after surgery.
• Treatment depends on how severe the infection is and where it is in your body. Your infection may be treated by draining infected material from the body. You may need antibiotic medicine, or in some cases, more surgery to treat the infection.
• You can help prevent infection by doing what you can to be as healthy as possible before your surgery, and following all pre-surgery instructions exactly. Make sure that everyone who visits you or examines you cleans their hands with soap and water or an alcohol-based hand rub.

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What is surgical site infection?

Surgical site infection is an infection that happens after surgery. You can have the infection in:

• The cut made in your body when you had the surgery
• The part of your body where you had the surgery, like your chest or belly
• The organ operated on, or a nearby organ, such as the kidneys or the area between your organs in your belly

Surgical site infection is a concern because:

• It causes more pain and discomfort as you recover from surgery
• It can cause serious, sometimes fatal illness
• You may need to stay at the hospital longer
• It will take you longer to recover from the surgery
• You may need more surgery to treat the infection
• It increases medical expenses

What is the cause?

Surgical site infection can happen in several ways. You have a greater risk if:

• You are a smoker and did not quit at least 30 days before surgery.
• Just before surgery, you shaved the area where your skin was going to be cut. Shaving with a razor can irritate your skin and make it easier to get an infection.
• You did not prepare for surgery as instructed by your healthcare provider. For example, if you had colon surgery, you did not clean out your bowel the day before surgery.

You also have a higher risk if you have:

• Cancer
• AIDS/HIV
• A long-term illness, such as diabetes, heart disease, or lung problems
• An open wound from injury, surgery, or a serious burn
• An infection from another part of your body that may spread to the surgical site

You are at higher risk if you are obese, elderly, or taking medicines such as steroids or anticancer drugs. These medicines can make it harder for your body to fight infection.

An infection after surgery can happen if healthcare providers do not:

• Clean their hands and arms before the surgery
• Properly clean your skin before surgery
• Give you antibiotic medicine at the right time before surgery
• Properly remove hair near the surgery site
• Keep all equipment sterile

Infection can also start after surgery if:

• The wound is not cared for properly in the hospital or after you go home
• Healthcare providers do not clean their hands well before and after caring for you
• The place where you have an IV is not carefully checked or changed, if needed, to prevent infection

The infection may start in the hospital or it may not start until several days after you have gone home. The less time you stay at the hospital, the lower your risk of a surgical site infection.

Some bacteria have become resistant to many antibiotic medicines. This means that the antibiotic medicines no longer kill the bacteria. Some bacteria are resistant to all known antibiotic medicines. These infections are very hard to treat and can become life threatening.

What are the symptoms?

Symptoms of a wound infection may include:

• Redness, swelling, or drainage of pus from any wounds, including where an IV goes into your skin
• Drainage of cloudy fluid from your surgical wound
• Fever and chills
• Increased pain at the site of infection or surgery

If the infection spreads to your blood, you may have:

• Body aches
• Nausea or vomiting
• Fast heartbeat
• Dizziness or fainting when you stand up
• Confusion, especially in older adults

How is it diagnosed?

Your healthcare provider will examine the surgical site. You will have blood tests to look for signs of infection. A sample of blood or fluid from the wound may be sent to the lab and tested. If you have an infection, it may take several days to find out what kind of germ is causing it. Knowing what germ is causing the infection helps your provider choose the right medicine to treat it.

If the surgical infection is inside your body, you may need special X-rays or ultrasound scans to look for a collection of pus in your belly, chest, or pelvis.

How is it treated?

Treatment depends on how severe the infection is, and where it is in your body. The infection may be treated by draining infected material from the body, which may be done at the hospital or in your healthcare provider’s office. If the infection happens after you leave the hospital, you may need to go back into the hospital.

You may need IV antibiotics or another medicine that will kill the germ causing the infection.

In some cases, you may need more surgery to treat the infection.

Ask your provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent a surgical infection?

You can help by doing what you can to be as healthy as possible before your surgery. For example:

• If you smoke, try to quit at least 30 days before surgery.
• If you have diabetes, keep good control of your blood glucose level.

Make sure you understand and follow all pre-surgery instructions exactly as they were given to you. Tell your healthcare provider if you have any infections, such as a bladder infection or a cold, just before surgery is scheduled. Also tell your healthcare provider about any antibiotics you are taking. Be sure to talk to your provider about the risk of infection and how to prevent it.

After your surgery:

• Make sure that your healthcare providers clean their hands before examining you, either with soap and water or an alcohol-based hand rub.
• Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, ask them to clean their hands.
• Family and friends who visit you should not touch the surgical wound or dressings.