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Thread: Surgical Site Infection (SSI) Prevention

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    PharmD Year 1 TomHsiung's Avatar
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    Default Surgical Site Infection (SSI) Prevention

    Determinants of SSI
    Whether a wound infection occurs after surgery depends on a complex interaction between the following: 1) patient-related factors, 2) procedure-related factors, 3) microbial factors, and 4) use of preventive measures.

    Sources of Wound Bacteria
    Numerous organisms have been described as wound pathogens, and the origin of the inoculum is not established with certainty for most infections. The patient's endogenous skin flora, with gram-positive organisms in general, and staphylococcal species, in particular, is the predominant cause of incisional infections of clean surgical procedures. Modern methods of antisepsis can reduce but not eliminate the skin-associated bacteria of surgical patients. This limitation derives, in part, from the localization of up to 20% of skin-associated bacteria in skin appendages, such as hair follicles and sebaceous glands. Because these sites are beneath the skin's surface, bacteria residing there are not eliminated by topical antisepsis. Transection of these skin structures by surgical incision may carry the patient's resident bacteria deep into the wound and set the stage for subsequent infection.

    For contaminated procedures, wound pathogens frequently are among the bacterial species that comprise the normal flora of the viscus entered during the surgical procedure. Enteric gram-negative pathogens and anaerobic bacteria are common pathogens of wounds after colonic procedures, and polymicrobial infections are common in this setting. Infection by a particular species, however, does not correlate directly with its quantitative presence among the normal flora but by the particular virulence attributes of bacteria.

    Although numerous source of bacterial contamination of surgical wounds have been described, it is virtually impossible impossible to identify with certainty the source(s) and route(s) of contamination. The direct inoculation of a patient's endogenous flora at the time of surgery is believed to be the most common mechanism; however, others undoubtedly occur. Transmission from contaminated surgical instruments or surgical material, hematogenous seeding from preexisting infection of a nonfood site, and contamination from either the skin, mucous membranes, or clothing of operating room staff have been implicated as potential sources of microbial contamination.

    Summary

    • The patient's endogenous skin flora
    • Skin-associated bacteria in skin appendages
    • Bacterial species that comprise the normal flora of the viscus entered during the surgical procedure
    • The direct inoculation of a patient's endogenous flora at the time of surgery is believed to be the most common mechanism
    • Transmission from contaminated surgical instruments or surgical material, hematogenous seeding from preexisting infection of a nonfood site
    • Contamination from either the skin, mucous membranes, or clothing of operating room staff

    Last edited by TomHsiung; Thu 1st December '16 at 4:19pm.
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease.

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