Gupta AS

Surgical site infections (SSI) are a surgeons nightmare. These infections can occur in any part of the body where operative intervention has been performed and cutaneous or mucosal areas have been breached. Post-surgical infections increase the morbidity, expenses and litigation's. Almost 40% of nosocomial infections are due to surgical site infections and about 1/3rd post operative deaths to some extent have a SSI as a significant contributory factor.
Proper preoperative, intraoperative and postoperative care, strict adherence to asepsis protocols, can prevent or at least reduce their occurrence.
SSI can range from life threatening sepsis to trivial, irritating wound discharge. SSI can have long term consequences like cosmetically unacceptable, distorted, ugly scars, with persistent complains of itching and pain. They also may restrict function of the part that these scars affect. SSI also have a considerable emotional impact on the patient.
Center for Disease Control (CDC) has categorized these SSI into two; superficial incisional and deep incisional or involving organ space. Both of these occur within 30 days of the operative procedure. Superficial variety involves only skin or subcutaneous tissue of the incision along with one of the remaining four features that includes either purulent drainage, with or without microbiological confirmation, or isolation of micro organisms from an aseptically obtained culture of fluid or tissue from the superficial incision or the presence of at least one of the following sign or symptom of infection like pain/ tenderness, localized swelling, redness, or heat or diagnosis of superficial incisional SSI is made by the surgeon or attending physician who has deliberately opened the incision and that wound is found to be culture-positive.
Deep SSI also occurs within 30 days, however, they can occur up to a year of surgery if an implant is present and can be implicated for the same. Deeper tissues like fascia and muscle layers are affected. The above criteria along with at least one of the remaining four features listed below is also identified is required to categorize the SSI as “Deep SSI”. The four criterion include occurrence of purulent drainage from the deep incision but not from any organ/ space component of the surgical site or spontaneous dehiscence of a deep incision or opening of the incision by the surgeon due to the presence of fever (> 38 °C), localized pain, or tenderness, and wound site is culture positive or diagnosis of superficial incisional SSI is made by the surgeon or attending physician. If an abscess or other evidence of infection involving the deep incision is found on direct examination, during re-operation, or by histopathological or radiological examination then this fourth feature will also contribute in defining the placement of the SSI in the Deep SSI category.
The wound infections are associated with various factors such as the surgeon’s experience, surgery performed, type of wound, the patient profile and other co-morbid factors. Center for Disease Control and Prevention has developed guidelines for prevention of infection, appropriate selection and proper timing of the pre-op antibiotics, proper skin preparation and skin hygiene. Despite advanced infection control practices, like improved operating room ventilation, sterilization methods, barriers, surgical technique, antimicrobial prophylaxis, surgical site infections are the cause for substantial amount of morbidity and mortality.
One such consequence of a Deep SSI resulted in the formation of a sinus tract that is published in this issue. We hope our discerning readers find the second issue in our 5th year engrossing.