Skip to Main Content

Chapter 73: Surgical Site Infections

Erin E. Shaughnessy; Thomas J. Sitzman

DEFINITIONS AND EPIDEMIOLOGY

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place.1,2 National rates of SSI in children range from 1.8%3 to 2.5%.4 However, SSI rates vary according to the specific center and also according to the type of surgery.4 Surgical procedures with elevated rates of SSI in children include cardiothoracic (2.3–5%),5 neurosurgical ventricular shunt (5.7–10.4%),6 and spinal fusion (4.4–10.2%).7–9

For the individual, an SSI can lead to prolongation of the hospital stay, additional surgical interventions, the risk of further complications, and unnecessary pain and anxiety. For society, the treatment of these largely preventable complications substantially increases the overall cost of healthcare.10–13

The Centers for Disease Control and Prevention (CDC), via the National Healthcare Safety Network, maintains a standard definition of SSI, enabling research and improvement efforts into prevention of SSI2 (see also Table 73-1 and Figure 73-1). In 2017 the definition was updated, reducing the length of surveillance for SSI following certain procedures.2

TABLE 73-1Criteria for Defining Surgical Site Infections
View Table||Download (.pdf)
TABLE 73-1Criteria for Defining Surgical Site Infections
Type of SSI Timing Anatomic Location Clinical Criteria Comments
Superficial incisional <30 days* Skin and/or subcutaneous tissues

At least one of the following:

 Purulent drainage from superficial incision

 Positive wound culture

 Signs of infection† and wound is opened by surgeon‡

 Diagnosis of superficial incisional SSI made by surgeon

Do not report: stitch

abscess,

circumcision,

episiotomy, or burn

infections
Deep incisional <30 days* Fascia and/or muscle

At least one of the following:

 Purulent drainage from deep incision

 Signs of infection and wound is opened by surgeon or wound dehisces‡

 Abscess or infection noted on examination, at reoperation, or by medical imaging

 Diagnosis of deep incisional SSI made by surgeon

 Report infections that involve both superficial and deep tissues as deep incisional SSI
Organ/Space <30 days* Organ or space that was opened during surgery

At least one of the following:

 Percutaneous aspiration of pus from organ/space

 Positive organ/space fluid culture

 Abscess or infection noted on examination, at reoperation, or by medical imaging

 Diagnosis of organ/space SSI made by surgeon

 Report organ/space infections that drain through the incision as organ/space SSI

*Up to 90 days for specific procedures; see CDC SSI event definition.1

†Pain or tenderness, localized swelling, redness, or heat.

‡Unless wound cultures are negative.

Adapted with permission from Centers for Disease Control (CDC). Surgical-site infection (SSI) event: National Healthcare Safety Network Patient Safety Component Manual 2013. Available online at: www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf. Accessed June 26, 2018.

FIGURE 73-1.

Cross section of abdominal wall depicting Centers for Disease Control and Prevention (CDC) classifications of surgical site infection.

image
View Full Size||Download Slide (.ppt)

Several ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close