How Can I Lower the Risks of Surgical Site Complications?

What are the risk factors for a surgical site infection?

A variety of instruments used to make and close surgical incisions

The likelihood of a wound infection after surgery is between 1 and 3 percent. However, the impact of developing an infection can be devastating. Taking care of a surgical incision is an important concern after surgery. Medical issues such as diabetes or a weakened immune system increase the risk of developing a surgical wound infection. Smoking, advanced age, poor nutrition, lengthy procedures (greater than 2 hours), and being overweight also increase the risk of surgical site infections. Mitigating these medical issues and optimizing overall health whenever possible are of critical importance for the reduction of surgical site complications.

What are the classifications for surgical site infections?

The Centers for Disease Control and Prevention (CDC) have developed a surgical site infection (SSI) risk assessment based on the American Society of Anesthesiologists’ Physical Status Classification System score. The surgical wound type classification reflects an individual’s state of health prior to the procedure, the state of contamination to the surgical site, the duration of the operation, and the technical aspects of the procedure. This assists the surgeon’s plan of care for preoperative, intraoperative, and postoperative infection control measures.

These surgical site classifications include:

  • Clean wounds – These surgical sites show no signs of infection or inflammation and do not involve repairing or removing an internal organ. They often involve the eyes, skin, or vascular system. The risk for an infection in this type of wound is usually less than 2%.
  • Clean-contaminated – These surgical sites have no signs of infection at the time of surgery but do involve repairing or removing an internal organ. Examples of this type of wound include lung surgery, appendix removal, and gynecological procedures. The risk for infection is usually less than 10%.
  • Contaminated – These surgical sites include open, fresh traumatic injury wounds or wounds that involve repairing or removing an internal organ. Blood and other fluids can spill from the organ into the surgical site. The risk for an infection is usually 13-20%. Incisions after surgery that involves the gastrointestinal tract may be at a higher risk of becoming infected.
  • Dirty-contaminated – These are surgical sites that have an infection that is already present at the time of surgery. The risk for an infection in these cases is usually about 40%.

How can patients prepare for surgery?

A patient discussing post-operative wound care with their physicianPreparations for surgery are specific to the individual, should be planned as early as possible, and are best directed by the care provider. Surgical wound infections can significantly impact a patient, reduce quality of life, and impose an undue financial burden on both the patient and healthcare system. With more than half of surgical site infections estimated as preventable, a holistic plan of care and evidence-based practices may significantly reduce the incidence of surgical site infections.

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Susan has 30+ years of clinical experience across the continuum of care. Her experience includes direct patient care in critical care and wound care. She has demonstrated clinical and sales leadership roles with wound management organizations such as Healogics, and industry experience with companies such as HealthPoint. Her broad experience from bedside to innovation and industry has provided a unique perspective that she has shared as a consultant and educator. She has been actively involved with the Wound, Ostomy, Continence Society and has many years of service on the board of directors for the Association for the Advancement of Wound Care, and the American Board of Wound Management of which she also served as President. She is currently vice-chair for the American Board of Wound Management Foundation.