Surgical Site Infection — SAQ

Stem

A 60-year-old diabetic man undergoes elective open appendicectomy for chronic appendicitis. On postoperative day 5, the wound is erythematous with purulent discharge. Temperature 38.2C, WBC 14.5.

Questions

a) What is the diagnosis and CDC classification? (2 marks)

Superficial incisional SSI: infection involving skin and subcutaneous tissue only, occurring within 30 days of surgery. Features: erythema, purulent discharge, fever, leukocytosis.

b) Name four risk factors for SSI in this patient. (2 marks)

1. Diabetes mellitus (impaired neutrophil function, poor wound healing)
2. Age over 60
3. Open (vs laparoscopic) surgery
4. Wound contamination (appendix = clean-contaminated)

c) Describe four measures to PREVENT SSI. (4 marks)

1. Prophylactic antibiotics within 60 minutes before incision (appropriate for wound class)
2. Normothermia (maintain core temp 36 to 37C)
3. Glycaemic control (blood glucose under 11 mmol/L in diabetics)
4. Aseptic technique and skin preparation (chlorhexidine)

Also: hair removal by clipping (not shaving), supplemental O2, laparoscopic approach.

d) How would you manage this patient's SSI? (2 marks)

1. Open the wound (remove sutures/staples) to allow drainage
2. Wound swab for culture and sensitivity
3. Wound care (regular dressings, saline irrigation)
4. Targeted antibiotics if surrounding cellulitis or systemic signs (flucloxacillin for suspected S. aureus)
5. Monitor for improvement; consider debridement if necrotic tissue