Surgical Site Infections

One risk of having surgery is an infection at the surgical site. The surgical site is any cut the surgeon makes in the skin to do the operation. Surgical site infections can range from minor to severe or even fatal.

What Causes Surgical Site Infections?

Germs are everywhere. They're on your skin, in the air, and on things you touch. Many germs are good. Some are harmful. Surgical site infections occur when harmful germs enter your body through the incision in your skin. Some infections are caused by germs that are in the air or on objects. But most are caused by germs found on and in your own body.

Who Is at Risk for Surgical Site Infections?

Anyone can have a surgical site infection. Your risk is greater if you:

  • Are an older adult
  • Have a weak immune system or other health conditions or illnesses such as diabetes
  • Take certain medicines such as steroids
  • Are a smoker
  • Have certain types of operations, such as abdominal surgery
  • Have poor nutrition
  • Are overweight
  • If the operation lasts longer than two hours

What Are the Symptoms of a Surgical Site Infection?

  • The infection usually starts with increased skin redness, pain, and swelling around the incision. Later you may notice a cloudy or greenish-yellow discharge from the incision and it may develop a foul odor. The incision may separate or open up. You are also likely to have a fever and may feel very ill.
  • Symptoms can appear any time from hours to weeks after surgery. Implants such as an artificial knee or hip can become infected at any time after the operation.

How Are Surgical Site Infections Treated?

  • Surgical site infections are treated with antibiotics. The type of medicine you get will depend on the germ thought to be causing the infection. Most serious wound infections need local wound care, and in some cases, further surgery.
  • An infected skin wound may be reopened and cleaned. Sometimes, deep wounds need to be packed with gauze that is changed often until the wound starts to heal from the inside out. Your healthcare provider will figure out the best care needed to treat your surgical site infection.
  • If an infection occurs where an implant is placed, the implant may be removed.
  • If you have an infection deeper in your body, you may need another operation to treat it.

Hospital Prevention of Surgical Site Infections

We take these steps to help prevent surgical site infections:

  • Hand washing. Before the operation, your surgeon and all operating room staff scrub their hands and arms with an antiseptic soap.
  • Clean skin. The site where your incision is made is carefully cleaned with an antiseptic solution.
  • Sterile clothing and drapes. Members of your surgical team wear medical uniforms (scrub suits), long-sleeved surgical gowns, masks, caps, shoe covers, and sterile gloves. Your body is fully covered with a large sterile sheet (sterile drape) except for the spot where the incision is made.
  • Clean air. Operating rooms have special air filters and positive pressure airflow to prevent unfiltered air from entering the room.
  • Careful use of antibiotics. Antibiotics are given no more than 60 minutes before the incision is made and stopped within 24 hours after surgery. This helps kill germs but avoids problems that can occur when antibiotics are taken longer.
  • Controlled blood sugar levels. Your blood sugar level may rise because of the stress of the surgery. Your blood sugar level is watched closely to make sure it stays within a normal range. High blood sugar delays wound healing and increases the chances for infection.
  • Controlled body temperature. A lower-than-normal temperature during or after surgery prevents oxygen from reaching the wound and makes it harder for your body to fight infection. Hospitals may warm IV fluids, increase the temperature in the operating room, and provide warm-air blankets.
  • Proper hair removal. Any hair that must be removed is clipped right before the incision, not shaved with a razor. This prevents tiny nicks and cuts through which germs can enter.
  • Wound care. After surgery, a closed wound is covered with a sterile dressing for a day or two. Open wounds are packed with sterile gauze and covered with a sterile dressing.

What You Can Do to Prevent Surgical Site Infections

  • Ask questions. Learn what your hospital is doing to prevent infection.
  • If your doctor tells you to, shower or bathe with plain soap the night before and the day of your operation. Follow the instructions you are given. You may be asked to use a special cleanser that you don't rinse off.
  • If you smoke, stop for the longest duration possible before and after the operation. Ask your doctor about ways to quit. 
  • Take antibiotics only when your healthcare provider tells you to. Using antibiotics when they're not needed can create germs that are harder to kill. Also, finish all your antibiotics, even if you feel better.
  • Be sure healthcare workers clean their hands with plain soap and water or with an alcohol-based hand cleaner before and after caring for you. Don't be afraid to remind them.
  • After surgery, eat healthy foods.
  • Care for your incision as directed by your doctor or nurse.

Hand Washing Reduces the Risk of Infection

Good hygiene, such as frequent hand washing and daily skin cleansing promotes good health. Daily skin cleansing helps to remove bacteria that may cause disease.

When to Seek Medical Care

Call your healthcare provider if you have any of the following:

  • Increased soreness, pain, or tenderness at the surgical site
  • A red streak, increased redness, or puffiness near the incision
  • Yellowish, cloudy, or bad-smelling discharge from the incision
  • Stitches that dissolve before the wound heals
  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider
  • A tired feeling that doesn't go away

Using Hibiclens

Preparing or "prepping" skin before surgery can reduce the risk of infection at the surgical site. Hibiclens liquid soap contains Chlorhexidine Gluconate (CHG) which is an antiseptic solution.

Use Hibiclens liquid soap in the shower for two nights prior to surgery.

Hibiclens General Instructions

  • Hibiclens is not to be used on the head or face, keep out of eyes, ears and mouth.
  • Hibiclens is not to be used in the genitalia area.
  • Hibiclens should not be used if you are allergic to chlorhexidine gluconate.
  • Hibiclens is not to be used on wounds other than superficial wounds.

Hibiclens Instructions for Bath or Shower

  • If you plan to wash your hair, do so with your regular shampoo, then rinse hair and body thoroughly to remove any shampoo residue.
  • Wash your face with your regular soap or water only.
  • Thoroughly rinse your body with warm water from the neck down.
  • Use Hibiclens as you would any other liquid soap and rinse thoroughly with warm water.
  • Do not use your regular soap after applying and rinsing with Hibiclens.
  • Do not apply any lotions, deodorants, powders or perfumes to the body area that have been cleaned with Hibiclens.
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