Surgical Wound Infection

What is a surgical wound infection?

A surgical wound infection (surgery site infection) is an infection that develops after you have surgery. These infections happen when bacteria get into your body through the incisions (cuts) your surgeon makes. They don’t happen often, in part because healthcare providers and hospitals work hard to prevent them. If you’re having surgery, don’t hesitate to ask your surgeon about steps they take to reduce your risk.

Types of surgical wound infections

The U.S. Centers for Disease Control and Prevention (CDC) lists three types of surgical wound (surgical site) infections:

• Superficial incisional infection (SSI): You have an infection around the skin where your surgeon made an incision. SSIs account for more than 50% of all surgical infections.
• Deep incisional SSI: This may be an infection in muscles or the connective tissue that separates your muscles or encloses your organs. An infection that happens after incisions (cuts) in your sternum (breastbone) is an example of a deep incisional infection.
• Organ or space SSI: Surgery on one part of your body can affect nearby organs or the space between organs, like when your surgeon needs to gently move an organ aside during surgery. That’s when you may develop an organ or space SSI.

How common are surgical wound infections?

The U.S. CDC estimates 1 to 3 in 100 people who have surgery develop a surgical site infection.

What are the symptoms of a surgical site infection?

Symptoms typically develop three to seven days after surgery. Your symptoms may vary depending on the type of surgery that you had. In general, signs of an infection include:

• Thick, cloudy, white- or cream-colored discharge from the wound
• Noticeable odor from the incision
• An opening in the incision line (the line may get deeper, longer or wider)
• Redness or color changes in your skin that go beyond the edge of the incision
• Pain when you touch the wound or the area around the wound
• The incision area feels warm or hot to your touch
• Fever (greater than 101 degrees Fahrenheit or 38.4 degrees Celsius)
• Chills
• Sweating

What causes a surgical wound infection?

Bacteria cause surgical wound infections. There are millions of different bacteria, but the ones that typically cause surgical wound infection are:

• Staphylococcus aureus: This is the most common form of Staphylococcus bacteria and the one responsible for staph infections. About 30% of us have these bacteria living in our noses. In most situations, they’re harmless until they get inside your body.
• Streptococcus pyogenes (Group A Streptococcus): This is the bacterium that causes strep throat. The bacteria live in people’s noses and throats and may spread when people sneeze, cough or talk.
• Enterococci: These bacteria live in your intestinal tract. They usually don’t cause disease unless they move from your intestinal tract to parts of your body that aren’t supposed to have bacteria. For example, if enterococci in your large intestine spill into your belly during surgery, you may develop a surgical wound infection.
• Pseudomonas aeruginosa: Surgical wound infections involving these bacteria may happen if you have them on your skin or they’re on a medical device, like a urinary catheter or a ventilator.

How do these bacteria get into our bodies during surgery?

The most common ways bacteria get into surgical wounds and cause infections are:

• Self-contamination: There are bacteria on our skin, mucus membranes and in our gastrointestinal systems. Bacteria on the surface of your skin can get into a surgical wound. Surgery that involves your gastrointestinal tract may lead to an infection.
• Direct contact: This is when bacteria on medical equipment or your care team’s hands enter the surgery site.
• Airborne contamination: The air around us is filled with microorganisms, like in respiratory droplets when someone sneezes.

What are the risk factors for surgical wound infection?

Your surgeon considers your overall health when they plan your surgery. Several conditions or activities may increase your infection risk:

• Diabetes
• Existing infection
• Malnutrition
• Obesity
• Smoking
• Weakened immune system or taking immunosuppressants

Healthcare providers also consider your risk of infection by the kind of surgical wound that you have. Surgical wound classifications are:

• Clean wounds: In a clean wound, there’s no sign of inflammation or contamination at the surgery site, and the surgery doesn’t involve operating on an internal organ.
• Clean-contaminated wounds: Your surgery involves an internal organ, but there’s no sign that the organ is infected.
• Contaminated wounds: In this situation, the surgery involves an internal organ that may spill its contents into the wound.
• Dirty wounds: This doesn’t mean there’s dirt in the wound. It means you have an existing infection that increases the risk of your surgical wound becoming infected.

What are the complications of surgical wound infections?

In general, a surgical wound infection keeps you from recovering from surgery because your wound can’t heal. Other potential complications may include:

• Abscess
• Cellulitis
• Osteomyelitis
• Sepsis

How do healthcare providers diagnose a surgical wound infection?

Your surgical team will diagnose a suspected infection after surgery. They’ll ask when your symptoms started and if any symptoms got worse over time. To identify the bacteria causing the infection, they’ll take a sample of any pus or liquid seeping from the wound. They may need to remove a few stitches or staples to get a sample.

What are treatments for surgical wounds?

Antibiotics are the most common treatment for surgical wounds. In some cases, your surgeon may do a procedure to remove the infection.

What can I expect if I have a surgical wound infection?

If you’re like most people, antibiotics will take care of the infection. But you’ll need to continue protecting your surgical wound until it heals so you don’t develop a new infection. Your care team will explain how to take care of the surgery site. But don’t hesitate to ask questions.

Can surgical site wounds be prevented?

Healthcare providers and hospitals constantly work to reduce the risk of surgical wound infections. Providers in the U.S. follow guidelines set by the Centers for Disease Control and Prevention. The World Health Organization sets similar guidelines. Many hospitals have patient safety programs that outline steps providers take to reduce the risk of surgical wound infections. If you’re having surgery, ask your surgeon to explain the steps they’ll take to reduce your risk.

What can I do to reduce my risk?

Taking the following steps before your surgery may reduce your risk:

• Share information: Make sure your surgeon knows about any existing medical issues, like allergies, diabetes or having obesity, which may increase your risk of infection.
• Quit smoking: Smoking, including using e-cigarettes, increases your risk.
• Don’t shave near the surgery site: Shaving with a razor can irritate your skin. Even the smallest cut from a razor may create a path for bacteria.
• Consider antiseptic cleansers: Ask your surgeon if you should use an antiseptic cleanser when you shower before your surgery.

After your surgery, make sure your healthcare providers clean their hands before they examine the surgery site. Protecting you from infection is very important to your providers, and this may be something they always do. But if they don’t, feel free to ask them to clean their hands before they touch you.

The same goes double for visiting friends and family. Everyone should wash their hands with soap and water or an alcohol rub. And they should never touch the wound.

How do I take care of myself?

The most important thing is to follow your surgeon’s guidance. If you have a surgical wound infection, they may have specific instructions on how to take care of the wound, so you don’t develop another infection. Here are some other suggestions:

• Keep moving: Movement gets your blood pumping. That sends oxygen to your muscles and tissues, which will help them heal. Your care team may recommend activities you can do at home. But be sure to take it slow.
• Make calories count: If you had a surgical wound infection, your body’s been doing double duty — fighting the infection while healing from surgery. Make sure your nutrition includes protein, iron, zinc and vitamins A and C.

When should I see my healthcare provider?

Contact your provider if infection symptoms get worse, even if you’re taking medication, or come back. Keep an eye on your wound for signs of:

• Swelling or redness
• Pain when you gently touch the area
• Pus or discharge from the wound