SURGICAL site infections or SSIs are common complications in patients who have undergone surgery.
It is one of the global health problems with morbidity, mortality and financial consequences.
SSIs would happen when bacteria enters the surgical wound after surgery, viz the incision site, said Prof Dr Sasheela Sri La Sri Ponnampalavanar.
“The bacteria gets inside and causes an infection,” the consultant infectious diseases physician said in a webinar titled “Are you or your loved one having a surgery soon?”.
“The common source of the bacteria can be from the patient’s skin or during the patient’s care in the hospital.
“Infections that are acquired in the hospital are commonly due to a multi-drug resistance bacteria, or bacteria not responsive to commonly used antibiotics,” she said.
She was one of two speakers at the webinar organised by Star Media Group with healthcare company Johnson & Johnson as education partner.
Prof Sasheela said the prevalence of SSIs was high in low- and middle-income countries (LMICs) compared to high-income countries.
Citing a report from World Health Organisation, she said more than one in 10 people who have had surgery in LMICs got SSIs.
“People’s risk of getting SSIs in LMICs is three to five times higher than in high-income countries.
“Around 1% of people who have surgery in USA get SSI. And SSIs contribute to patients there spending more than 400,000 extra days in hospital, costing US$10bil (RM42bil) a year,” she added.
Fellow speaker Prof Dr Azlina Amir Abbas said with SSIs a lot depended on the exact location of an infection.
“Sometimes, a patient has it on the skin but occasionally it can be deeper; it can involve deeper organs, the joints or even bones. So, an infection may be superficial or deep.”
She was replying to a question by moderator and Johnson & Johnson Sdn Bhd medical manager Natalie Lim on whether all SSIs were the same.
Prof Azlina is a consultant orthopaedic surgeon and an academician at a public university.
She is currently a member of the Health Ministry’s Technical Working Group for Development of Guidelines for Prevention of Surgical Site Infection. She is also past president of the Malaysian Orthopaedic Association.
Patients could develop infections within 30 days, or even up to a year after surgery, she said.
“Treating such infections could also be costly as it would involve readmission to hospital.
“If the patient is already readmitted, their hospitalisation may be extended further.
“There is added costs for investigation to look for these infections.
“It is not only blood tests that tells us that there is an infection, but also the need to send samples for culture to identify the organism that is involved,” she explained.
She added that it was crucial to find out the type of bacteria that was causing all the trouble “so that we can have targeted antibiotic therapy for the patient”.
On the most common cause of SSIs, Prof Azlina said there were multiple factors.
“Certain medical conditions place patients at higher risk of infection, such as patients with underlying diabetes mellitus or patients on immunosuppressive therapy.
“The underlying reason and type of surgery may also influence the occurrence of SSI,” she said, noting that the duration of surgery could also determine the risk for SSIs.
Fever, pain, discharge from the wound (such as pus or blood), redness and swelling around the wound area could be signs and symptoms of SSI, she said.
Generally, preventive measures could take place at the preoperative, intraoperative (during surgery) and postoperative periods, she said.
Preoperative measures include optimising the patient’s condition with a focus on a balanced and nutritious diet, and any medical condition (especially diabetes).
Bathing before surgery is strongly recommended, and clipping of hair at the area to be operated on is preferred to shaving, which has a higher risk of infection.
Intraoperative measures, said Prof Azlina, included using prophylactic antibiotics and using appropriate solutions to cleanse and prepare the skin prior to starting surgery.
“For example, common solutions that are used in orthopaedic surgery are alcohol-based povidone-iodine, and alcohol-based chlorhexidine.
“Other measures are limiting foot traffic going in and out of the operating room as well as keeping the patient warm, well-hydrated and well-oxygenated throughout and after surgery,” she said.
The postoperative measures include:
• keeping the wound clean — if dressing is necessary, it should be done using an aseptic technique;
• using appropriate prophylactic antibiotics for the appropriate duration;
• bathing in most instances is allowed but also depends on the type of surgical procedure that has been performed; and
• keeping blood sugar levels under control.
Prof Sasheela said hand hygiene was important in caring for a patient with a post-operative wound.
“Studies have shown that 60% of SSIs are actually preventable,” she added.
Although SSIs were not contagious, she said it could lead to death.
Prof Azlina also said that the quality of a patient’s life could be severely affected by a bad infection.
“Patients who feel unwell should seek help as soon as possible, and not opt to self-treat with antibiotics from pharmacies as it may not be the appropriate one,” she said.