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St. Joseph's Health Centre Toronto

What are Surgical Site Infections (SSIs)?

Surgical site infections occur when harmful germs enter your body through the surgical site (any cut the surgeon makes in the skin to perform the operation). Infections happen because germs are everywhere – on your skin, in the air and on things you touch. Most infections are caused by germs found on and in your body.

What are the symptoms of SSIs?

Usually, a combination of the following:

  • Increased soreness, pain, or tenderness at the surgical site.
  • A red streak, increased redness, or puffiness near the incision.
  • Greenish-yellow or bad-smelling discharge from the incision.
  • Fever of 101 degrees Fahrenheit or higher
  • A tired feeling that doesn’t go away

Symptoms can appear at any time from hours to weeks after surgery. Implants such as an artificial knee or hip can become infected a year or more after the operation.

What are the risk factors for SSIs?

The risk of acquiring a surgical site infection is higher if you:

  • Are an older adult
  • Have a weakened immune system or other serious health problem such as diabetes
  • Smoke
  • Are malnourished (don’t eat enough healthy foods)
  • Are very overweight

What should health care providers be doing to prevent SSIs?

Health care providers should be taking the following precautions to prevent SSIs:

  • Practicing proper hand-washing techniques. Before the operation, the surgeon and all operating room staff should scrub their hands and arms with an antiseptic soap.
  • Cleaning the site where your incision is made with an antiseptic solution.
  • Wearing medical uniforms (scrub suits), long-sleeved surgical gowns, masks, caps, shoe covers and sterile gloves.
  • Covering the patient with a sterile drape with a hole where the incision is made.
  • Closely watching the patient’s blood sugar levels after surgery to make sure it stays within a normal range. High blood sugar delays the wound from healing.
  • Warming IV fluids, increasing the temperature in the operating room and providing warm-air blankets (if necessary) to ensure a normal body temperature. A lower-than-normal body temperature during or after surgery prevents oxygen from reaching the wound, making it harder for your body to fight infection.
  • Clipping, not shaving any hair that has to be removed. This prevents tiny nicks and cuts through which germs can enter.
  • Covering your closed wound (closed with stitches) with sterile dressing for one or two days. If your wound is open, packing it with sterile gauze and cover it with sterile dressing.

Preventing SSIs: What patients can do

  • Ask lots of questions. Learn what steps the hospital is taking to reduce the danger of infection.
  • If your doctor instructs, shower or bathe with antiseptic soap the night before and day of your surgery. You may be asked to use a special antibiotic cleanser that you don’t rinse off.
  • If you smoke, stop or at least cut down. Ask your doctor about ways to quit.
  • Only take antibiotics when told by a health care provider. Using antibiotics when they’re not needed can create germs that are harder to kill. If prescribed, finish all your antibiotics, even if you feel better.
  • After your surgery, eat healthy foods.
  • Do not shave yourself before surgery.
  • When you return home, care for your incision as instructed by your health care provider.

How are SSIs treated?

  • Most infections are treated with antibiotics – the type of medication will depend on the germ causing the infection.
  • An infected skin wound may be reopened and cleaned.
  • If an infection occurs where an implant is placed, the implant may be removed.
  • If the infection is deep within the body, another operation may be needed to treat it.

St. Joseph's Public Reporting

What is being publicly reported?

As of April 30, 2009 the Ministry reports on its website:

  • The SSI-prevention percentage of primary hip/knee joint replacement surgical patients who received antibiotics within the appropriate time period before the surgery by hospital site.

What determines the rate?

*vancomycin is a type of antibiotic

What is the health care system doing with this information?

Hospital SSI-prevention provides one measure of patient safety and quality of care.

The information gathered will assist hospitals with evaluating the effectiveness of their infection prevention and control interventions and make further improvements based on this information.


Please see SSI Rates for more information.

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