Post Procedural Infection
An infection after surgery is a complication that can occur when bacteria enter the body through surgical incisions. While healthcare providers take strict precautions to prevent these infections, they remain a significant concern, affecting between 1 and 3 out of every 100 surgical patients and contributing to increased hospital stays, healthcare costs, and health complications.
Table of contents
- What Is a Post Procedural Infection?
- Types of Surgical Site Infections
- How Common Are These Infections?
- Signs and Symptoms
- What Causes These Infections?
- Who Is at Higher Risk?
- Bacteria Involved
- How Infections Are Diagnosed
- Treatment Options
- Preventing Infections
- Recovery and Outlook
What Is a Post Procedural Infection?
A post procedural infection, also called a surgical site infection (or SSI), is an infection that develops in the part of the body where surgery took place. These infections happen when bacteria (tiny organisms that can cause disease) get into your body through the cuts your surgeon makes during the procedure.[1][2]
Before modern medicine understood how infections spread, these complications were extremely common after surgery and often led to serious outcomes, including limb removal or death. However, once healthcare professionals began using antiseptic techniques (methods to prevent infection by killing or removing harmful microorganisms), patient outcomes improved dramatically.[1]
Despite these advances, surgical site infections continue to be the primary source of hospital-acquired infections in surgical patients, causing over 2 million infections in the United States each year.[1]
Types of Surgical Site Infections
The Centers for Disease Control and Prevention (CDC) classifies surgical site infections into three main categories based on how deep the infection goes.[1][2]
Superficial incisional infections affect only the skin and the tissue just below the skin where the surgeon made the cut. These are the most common type, making up more than half of all surgical site infections. You might see pus coming from the surgical site, or the area may be red, swollen, and painful.[1][2]
Deep incisional infections go deeper than the skin, affecting muscles and the layers of tissue that stabilize and enclose your muscles. These infections can be diagnosed if there’s pus from the deep surgical site, if the wound comes apart on its own, or if imaging tests like a CT scan show an abscess or infection in the deep tissues.[1][2]
Organ or space infections affect organs or the spaces between organs beyond where the cut was made. During surgery, a surgeon sometimes needs to gently move an organ aside to reach the area being operated on. This can lead to infections in those organs or spaces. These infections are diagnosed through drainage from special tubes placed in these areas, through finding bacteria in samples taken from these sites, or through imaging tests.[1][2]
Most surgical site infections occur within 30 days after surgery. For procedures that involve implanting a medical device, infections can develop up to one year after the operation.[1]
How Common Are These Infections?
The CDC estimates that 1 to 3 in every 100 people who have surgery develop a surgical site infection.[2][5] These infections don’t happen often, in part because healthcare providers and hospitals work hard to prevent them through strict cleanliness and safety procedures.[2]
Signs and Symptoms
Symptoms of a surgical site infection typically develop three to seven days after surgery, though the timing can vary depending on the type of surgery you had.[2]
If the surgical site itself is infected, you may notice thick, cloudy, white or cream-colored discharge draining from the wound. The wound may have a noticeable odor. The incision line may open up and become deeper, longer, or wider. You’ll likely see redness or color changes in your skin that go beyond the edge of the incision. The wound or the area around it may be painful when you touch it, or it may feel warm or hot to your touch. The area may also be swollen and hard.[2][3]
Infections can also affect your whole body, causing what doctors call systemic symptoms. These include fever (higher than 101 degrees Fahrenheit or 38.4 degrees Celsius), chills, sweating, a general feeling of being unwell, and lack of energy.[2][6]
Common types of infections that can develop after surgery include infections of the blood, pneumonia, and urinary tract infections.[6]
What Causes These Infections?
Bacteria cause surgical wound infections. Surgical wounds can become infected through several routes. Bacteria that are already on your skin can spread to the surgical wound. Bacteria from inside your body or from the organ that was operated on can cause infection. Bacteria in the environment around you during and after surgery can also be responsible.[2][3]
Most surgical wound infections come from the body’s own flora, which are microorganisms normally found on mucous membranes, skin, or hollow organs. Generally, the higher the concentration of these microorganisms, the greater the risk of wound infection. When there are more than 10,000 microorganisms per gram of tissue, the likelihood of a wound infection increases significantly.[1]
Who Is at Higher Risk?
Anyone who has surgery is at some risk of infection, but certain factors make some people more vulnerable than others.[2][3]
Older people face higher infection risks. People with weakened immune systems have difficulty fighting off infections. If you have poorly controlled diabetes, your body’s ability to heal is compromised. Being overweight or obese increases infection risk. Smoking interferes with healing and makes infections more likely.[2][3][9]
Taking certain medications, such as corticosteroids like prednisone, can make you more susceptible to infection. The type and length of surgery matter too. Surgeries that last longer than 2 hours carry higher risk. Certain types of surgery, such as operations to treat an existing infection like an abscess, also have higher infection rates.[3]
Bacteria Involved
There are millions of different bacteria, but a few types are most commonly responsible for surgical wound infections.[2]
Staphylococcus aureus is the most common form of Staphylococcus bacteria and the one responsible for staph infections. About 30% of people have these bacteria living in their noses. In most situations, they’re harmless until they get inside your body during surgery.[2]
Streptococcus pyogenes, also called Group A Streptococcus, is the bacterium that causes strep throat. These bacteria live in people’s noses and throats and may spread when people sneeze, cough, or talk.[2]
Enterococci are bacteria that 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 from your large intestine spill into your belly during surgery, you may develop a surgical wound infection.[2]
Pseudomonas aeruginosa infections may happen if you have these bacteria on your skin or if they’re on a medical device, like a urinary catheter or ventilator.[2]
Some wounds become infected with methicillin-resistant Staphylococcus aureus (MRSA), which is resistant to commonly used antibiotics. A MRSA infection requires a specific type of antibiotic to treat it.[3]
How Infections Are Diagnosed
Diagnosis of surgical site infections primarily relies on clinical evaluation by examining the wound and observing symptoms. Your doctor will check for signs of infection such as redness, warmth, swelling, discharge, and pain.[1]
If there is drainage from your wound, it may be tested in a laboratory to figure out exactly what bacteria is causing the infection and which antibiotic will work best to treat it.[3]
In some cases, imaging studies like CT scans may be necessary to identify deeper infections or abscesses that aren’t visible on the surface.[1]
Treatment Options
Antibiotics are the main treatment for most wound infections. The type of antibiotic depends on the bacteria causing the infection. You may start taking antibiotics through a vein (IV) and then switch to pills later. The length of time you’ll need to take antibiotics varies but will typically be at least one week. It’s important to take all of your antibiotics and complete the entire course of treatment, even if you start feeling better.[3]
Sometimes surgery is needed to treat the infection. Your surgeon may need to perform a procedure to clean the wound, which can be done in the operating room, in your hospital room, or in a clinic. During this procedure, the surgeon will open the wound by removing some or all of the staples or stitches, remove dead or infected tissue, rinse the wound with salt water solution, drain any pockets of pus, and pack the wound with special dressings before covering it with a bandage.[3]
Your surgical wound will need to be cleaned regularly and the dressing changed. You may learn to do this yourself, or nurses may do it for you. To help some surgical wounds heal, you may have a wound VAC (vacuum-assisted closure) dressing. This is a negative pressure dressing that includes a vacuum pump, a foam piece cut to fit the wound, and a vacuum tube, all covered with a clear dressing. This system increases blood flow in the wound and helps with healing. The dressing and foam piece are changed every 2 to 3 days.[3]
It may take days, weeks, or even months for the wound to be clean, clear of infection, and finally heal. If the wound does not close by itself, you may need a skin graft or muscle flap surgery to close it, but this won’t be done until after the infection has cleared.[3]
Preventing Infections
There are many steps you can take before, during, and after surgery to reduce your risk of infection.[5][9]
Before surgery, tell your healthcare provider about other medical problems you may have. Health problems such as allergies, diabetes, and obesity could affect your surgery and treatment. If you smoke, try to quit before surgery, as patients who smoke get more infections. Avoid shaving near where you will have surgery, as shaving with a razor can irritate your skin and make it easier to develop an infection. Follow any preparation instructions you’re given, including using special soaps or cleansers correctly.[5][9]
At the time of surgery, speak up if someone tries to shave you with a razor in the surgical area. Ask why it’s necessary and discuss any concerns with your surgeon.[5]
After surgery, if you don’t see your healthcare provider clean their hands, ask them to do so. Family and friends should not touch the surgical wound or dressings, and they should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. Always clean your hands before and after caring for your wound.[5][9]
Before you leave the hospital, make sure you understand how to care for your wound and know who to contact if you have questions or problems. At home, follow the care instructions you’re given carefully. Keep dressings clean and dry. Wash your hands before cleaning the surgical site or changing dressings. Take your medicines as directed. Maintain a healthy diet and stay well hydrated. Avoid tobacco. Don’t put anything on the surgical site, like ointment, unless your provider tells you to.[5][9]
Call your healthcare provider immediately if you have any symptoms of infection, such as redness and pain at the surgery site, drainage, fever, or chills.[5][9]
Recovery and Outlook
Some post procedural infections can be very serious, potentially resulting in organ failure or even death. However, when caught early, most infections are successfully treated with intravenous or oral antibiotics under close medical supervision.[6]
Recovery is not a straight line. There may be ups and downs, and some days will be better than others. This is perfectly normal. Being informed and proactive about your care can greatly improve your recovery journey.[1]
If the wound infection is not very deep and the opening is small, you will likely be able to take care of yourself at home with proper wound care and antibiotics. More serious infections may require hospitalization, additional surgeries, or longer courses of treatment.[3]
Surgical site infections can increase hospital stays by an estimated 7 to 10 days and increase hospitalization costs by 20%. However, with proper treatment and care, most people recover fully.[1]
