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Surgical Site Infection Prevention

A surgical site infection (SSI) is an infection that occurs after surgery, at the site where it was performed. These infections can affect the incision area or the deep tissue at the operation site. These infections can develop within 30 days after the surgery and up to one year after joint replacement or other surgeries involving an implant (including organ transplant, pacemaker, etc).

Surgical site infection prevention refers to the proper administration of antibiotics within the appropriate time prior to surgery to help reduce the risk of an infection. This performance is monitored and reported for all primary joint replacement surgeries, including total, partial or hemi arthroplasties (replacements) of the knee or hip joint.

Cause

Surgical site infections are caused by bacteria entering a surgical incision or wound. This bacterium is usually found in or on the patient's own body. Some surgeries are at higher risk for infections, especially in areas that have higher levels of bacteria. These surgeries include gastrointestinal surgery where there are bacteria present in the gastrointestinal tract, and emergency surgery such as appendicitis, acute cholecystitis and bowel perforation where there is active infection at the time of surgery.

The most common bacteria associated with SSIs are Staphylococcus aureus (a bacterium frequently found in the nose and skin of a person) and Escherichia coli (often known as E. coli).

What are the symptoms of surgical site infections?
  • Increased soreness, pain, or tenderness at the surgical site
  • A red streak, increased redness, or puffiness near the incision
  • Greenish-yellow or bad-smelling discharge from the incision
  • Fever of 38.5°C or higher
  • A tired feeling that doesn't go away
  • Symptoms can appear at any time from hours to weeks after surgery; implants such as an artificial knee or hip can become infected a year or more after the operation.
What are the risk factors for SSIs?
The risk of acquiring a surgical site infection is higher if you:
  • Are an older adult
  • Have a weakened immune system or other serious health problem such as diabetes
  • Smoke
  • Are malnourished (don't eat enough healthy foods)
  • Are very overweight

Treatment

How are SSIs treated?
  • Some infections are treated with antibiotics — the type of medication will depend on the germ causing the infection
  • An infected skin wound may be reopened and cleaned
  • If an infection occurs where an implant is placed, the implant may be removed
  • If the infection is deep within the body, a drainage procedure may be required.

Prevention


What is SSI prevention?
SSI prevention refers to the proper administration of antibiotics within the appropriate time prior to surgery. This performance statistic is monitored and reported for all primary joint replacement surgeries, including total, partial or hemi arthroplasties (replacements) of the knee or hip joint.
 
How do we prevent SSIs?
Several best practices help to prevent SSIs:
  1. The proper administration of prophylactic (preventative) antibiotics.
    North York General monitors and reports the appropriate use of (preventative) antibiotics for all hip and knee joint replacement surgeries.
  2. Appropriate hair removal at the surgical site.
  3. Monitoring and maintenance of the patient's body temperature at 36°C throughout the surgical procedure.

    Best practices such as # 2 and # 3 are monitored, but are not part of the reporting process.
For more information, please visit: theCanadian Patient Safety Institute.

What can patients do to help reduce their chances of infection?

Ask lots of questions. Learn what steps the hospital is taking to reduce the risk of infection.

If your doctor instructs, shower or bathe with antiseptic soap the night before and day of your surgery. You may be asked to use a special antibiotic cleanser that you don't rinse off.

If you smoke, stop or at least cut down. Ask your doctor about ways to quit.
Only take antibiotics when told by a health care provider. Using antibiotics when they're not needed can create germs that are harder to kill. If prescribed, finish all your antibiotics, even if you feel better.

After your surgery, eat healthy foods. When you return home, care for your incision as instructed by your health care provider.

Enhancing patient safety 

Patient safety and high quality clinical care are high priorities at North York General Hospital and we have become a leader in infectious disease control. We have made significant enhancements, including:
  • Working to implement best practices that help reduce SSIs. These include:
  • Optimal use of prophylactic (preventative) antibiotics:
       • Determining the appropriate antibiotic to be used
       • Administering these antibiotics within 0–60 minutes before surgery time
       • Discontinuing the antibiotic in less than 24 hours
  • Monitoring surgical patients' core body temperature and maintaining the temperature at a minimum of 36° Celsius throughout the entire surgery.
  • Enhancing our Infection Prevention and Control Program.

Performance

North York General regularly monitors and reviews infection rates and uses this information to execute best practice protective measures and continually improve patient care and safety.

The SSI prevention indicator is a measure of the hospital's proper administration of a prophylactic (preventative) antibiotic used to prevent surgical site infections in hip and knee joint replacement surgeries. This measure is reported on a quarterly basis. View the indicator for NYGH.

The SSI indicator is a process measure where we report the percent of total primary hip and knee surgical patients who receive prophylactic antibiotics within the appropriate time prior to surgery.