Recognising surgical site infection at home

What is a surgical site infection (SSI)?

After a surgical procedure most wounds heal without any problems but some experience complications such as infection. SSI delays wound healing and recovery and can cause psychological and physical distress, hospital readmission, longer hospital stays, additional surgical procedures, treatment in intensive care units, and greater rates of morbidity (illness) including sepsis and mortality (death). How common is SSI in Ireland? In 2022 Hospital Inpatient Enquiry (HIPE) data reports that following general surgery almost 3,000 patients in Ireland were diagnosed with either a dehiscence (opening) of an operation wound or a wound infection. The average length of stay for these patients was 24 days, with 52% having a hospital stay of less than 10 days. While SSIs can affect patients of any age the average age of patients affected was 54.8 years.

Tom's Story

Tom (59) was discharged from hospital four days following surgery (operation) for a ruptured (burst) appendix. A letter was sent to his GP to remove the surgical clips from his wound after 10 days and Tom was prescribed antibiotics for a further week. Eight days after his operation Tom started to feel unwell. He attended his GP who noticed some exudate (leakage) on his dressing and prescribed him a second antibiotic. Three days later Tom noticed that his dressing was now leaking through his clothes and his GP referred him back to the Emergency Department (ED). In ED his dressing was removed and a hole in his wound was visible. There was also leakage evident and the skin surrounding his wound was a red colour. Tom was diagnosed with an infected surgical wound dehiscence (the wound had opened). Tom was very upset and worried about getting sepsis. He was readmitted to hospital and required further surgery with a washout of his wound and application of a specialised advanced dressing called ‘topical negative pressure’. Following discharge, he was referred to the local Public Health Nurse for dressing changes three times a week which was difficult as Tom had to take time off work for another two weeks and arrange permission to attend the local health centre. It took two months from the first surgery to when Tom’s wound healed. Tom found the whole experience quite distressing and stressful, particularly the length of time that it took for the wound to heal.

How can I help prevent my wound becoming infected?

Patients (as well as health practitioners) play an essential role in both preventing wound infection and recognising the signs of an infection.

Before Surgery

• Do not shave on the day of the surgery
• Have a shower the day of, or the night before surgery

After surgery

• Practice good hand hygiene
• It is really important to avoid getting the dressing wet or touching it unnecessarily
• Keep well hydrated and follow a well-balanced diet to promote wound healing
• Ask your surgical team when you can return to exercise, this will vary by patient and surgery

What are the signs of SSI that I need to look out for?

• A fever (temperature above 38 Celsius)
• Chills or flu like symptoms
• Redness, swelling, pain, bleeding, unpleasant smell or any discharge from the wound site
• Nausea or vomiting that doesn't improve
• Pain that doesn't get better with medication

What do I do if I am experiencing any of these symptoms?

You need to contact your GP straight away, if it is out of hours contact the local out-of-hours doctor.

HSE National Improvement Programme in Wound Management

Ms. Gillian O’Brien Advanced Nurse Practitioner in Tissue Viability & Dermatology is the new clinical lead for the HSE National Improvement Programme in Wound Management. This quality improvement initiative under development within the National Quality and Patient Safety Directorate (NQPSD) aims to develop and support a comprehensive wound care improvement programme to positively impact patients’ experiences with wounds.

This Patient Safety Supplement was developed by:

• Ms Gillian O’Brien, National Clinical Lead, HSE National Improvement Programme in Wound Management
• Patients for Patient Safety Ireland
• Patient Safety Together, Incident Management Team, NQPSD, HSE

This supplement was approved for publication by the National Clinical Director, NQPSD & the HSE NPSA Committee .