All of the following are features of a major surgical site infection (SSI), except
excessive pain at the surgical site
The correct answer (the exception) is excessive pain at the surgical site. Surgical site infections are graded clinically as minor or major. A major SSI is defined by significant pus requiring the wound to be laid open, systemic illness (fever, tachycardia, leucocytosis, sepsis) and consequent delayed return home or readmission. Pain, erythema and induration without frank pus or systemic upset constitute a minor SSI, managed with dressings and oral antibiotics. Pain is therefore common to both and is not a defining criterion of major SSI.
Significant pus is the cardinal feature of major SSI and mandates drainage and debridement. Delayed return home, that is prolonged stay, readmission or a further operation, is part of the standard definition and drives the cost burden. Being systemically ill (temperature above 38 degrees C, tachycardia, raised CRP and leucocyte count) likewise defines major infection.
Key point: Major SSI equals pus plus systemic illness plus delayed discharge. CDC additionally classifies SSI anatomically as superficial incisional, deep incisional or organ/space, occurring within 30 days (90 days with an implant).
Important Questions from Pre-operative & Post-operative Care
- A surgeon is about to start a laparoscopic procedure on a patient. The floor nurse asks the surgeon about the identity of the patient, site of the procedure to be performed and any anticipated critical events during the surgery. These questions are a part of the
- Perioperative benefit from transfusion is with a haemoglobin level of
- A 60 year old lady underwent total abdominal hysterectomy. On the 3rd post operative day she suddenly became breathless while returning from washroom. Her blood pressure recorded was $80/50$ mm of Hg. The most probable diagnosis is
- Perioperative benefit from transfusion is with a haemoglobin level of
- A 20 year old patient underwent open hernia surgery four days back. He is running fever for the last one day and on local examination the operated site was wet with pus and surrounding redness and edema. The appropriate management would be:
