By Gregory Schultz, PhD
In my recent WoundSource webinar on the assessment and treatment of chronic wounds and biofilms, I discussed the pathogenesis of chronic wounds and offered a biofilm-based wound care protocol to promote healing.
By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWS, CWCN, CFCN
Part 1 in a series exploring topics related to surgical site infections.
Surgical site infections (SSIs) are the most common hospital-acquired infections, accounting for 20% of total documented infections each year and costing approximately $34,000 per episode. SSIs are responsible for increased readmission rates, length of stay, reoperation, patient morbidity and mortality, as well as increased overall health care costs.
As wound specialists, many of us have an intimate knowledge of the sequelae of surgical site infections. We utilize understanding of dressing properties in the role of meeting tissue requirements based on detailed wound assessment and patient-specific needs such as causative pathogenic organism, documented sensitivities, etc. While identifying the type of SSI is not necessarily requisite for adequate treatment, it is important to have a cursory knowledge of how SSIs are classified. SSIs are placed into three categories, which are defined by extent or depth of infection.
Superficial Incisional Surgical Site Infection – skin or subcutaneous tissue is involved, occurs within 30 days postoperatively, and must fulfill one of the following additional criteria:
Deep Incisional Surgical Site Infection – involves deep soft tissues such as fascia or muscle within incision, occurs within 30 days postoperatively without implant, occurs within 1 year if implant is in place and infection appears to be directly related to surgical procedure, and must fulfill one of the following additional criteria:
Organ/Space Surgical Site Infection – involves any part of the anatomy other than the incision, occurs within 30 days postoperatively without implant, occurs within 1 year if implant is in place and infection appears to be directly related to surgical procedure, and must fulfill one of the following:
*If both superficial and deep layers are involved, or if organ/space SSI drains through incision, classification will be deep incisional SSI.
Due to the deleterious effects on the patient, caregiver, and institution involved in the patient's care, numerous health care and regulatory organizations have launched large-scale efforts aimed to impact the occurrence of SSIs. Most have included various basic practices that institutions already widely utilize, while others have recommended the adoption of specialized approaches for when basic practices have not been sufficient in controlling SSIs. "Bundles" are often used, which refers to packaged groups of interventions commonly instituted to systematically address patient-specific risk factors, and encompass multiple aspects of prevention at various stages of patient care.
Understanding the basis for classification of SSIs will allow us to explore evidence-based strategies and rationales for prevention, which we will discuss in our next installment. And I'll end with a quote that seems quite fitting for the perpetual student in all of us:
"My mind rebels at stagnation; give me work, give me problems to solve." –Sherlock Holmes
About the Author
Samantha Kuplicki is board certified in wound care by both the American Board of Wound Management as a Certified Wound Specialist (CWS) and by the Wound, Ostomy and Continence Certification Board as a Certified Wound Care Nurse (CWCN) and Certified Foot Care Nurse (CFCN). She serves on the American Board of Wound Management (ABWM) Examination Committee and also volunteers for the Association for the Advancement of Wound Care.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.