Surgical Site infections

Updated 11/3/2022
Surgical Site infection (SSI), University foot and ankle institute

What is a surgical site infection? 

A surgical site infection (SSI) is a severe complication following a surgical procedure; as the name implies, it is an infection at the site of surgery.


At the University Foot and Ankle Institute (UFAI), our podiatrists are vigilant regarding foot and ankle surgery postoperative care and infection control. 


While an infected surgical wound may be superficial and only involve the skin, left untreated, the infection can spread. More serious SSIs can affect tissue, organs, or implanted material.

How common are surgical site infections?

SSIs have a significant impact on patient-reported outcomes and are a common source of patient anxiety in the postoperative period — particularly after hospital discharge when patients are responsible for their own wound care.


Surgical incision infections occur in 2-4% of patients and are the leading cause of hospital readmission. SSIs happen at or near the surgical incision within 30 days of the surgery — or within 90 days if prosthetic material is implanted. 


Surgical site infections can be extremely dangerous; they are fatal in 3% of patients. Fortunately, SSIs are also very preventable. 


What are the risks of SSIs? 

Our skin is a natural barrier that does an amazing job of protecting us against infection, but even with the best precautions and protocols in place, any break in the skin can put us at risk for infection.


Risk factors for contracting an SSI include:

  • other medical problems or diseases
  • age (older adults are at higher risk)
  • smoking
  • cancer
  • weakened immune system
  • diabetes


What are surgical site infection types? 

SSIs are commonly caused by these three bacteria: Staphylococcus, Streptococcus, and Pseudomonas. These pathogens may infect a surgical wound from casual contact — such as from the touch of a contaminated caregiver or surgical instrument, — germs in the air, or germs that are already on or in your body that spread into the wound.


There are different levels of wound infections:

  • Superficial — the infection is in the skin area only
  • Deep — the infection goes deeper than the skin into the muscle and tissue
  • Organ/space — a risk of intraabdominal surgeries, the infection is deep and involves the organ and space where you had surgery.


What are surgical site infection symptoms? 

An infected surgical wound will have one or more of the following symptoms:

  • redness, pain, warmth, or swelling at the surgical site
  • delayed healing
  • fever
  • pus or drainage from the wound site


What are the consequences of an infected surgical incision?

Although most infections are treatable with antibiotics, SSIs (superficial surgical site infections) remain a significant cause of morbidity and mortality after surgery. They are the leading cause of readmissions to the hospital following surgery, and approximately 3% of patients who contract an SSI will die as a consequence. Although SSIs are less common following ambulatory surgery than after inpatient procedures, they are a frequent source of morbidity in these patients as well.


One of the negative aspects of SSI is that doctors need to prescribe antibiotics to kill infectious bacteria. Antibiotic resistance occurs when bacteria change so that antibiotic medicines can’t destroy them. Bacterial infections then become extremely difficult to treat.


Some wounds are infected with methicillin-resistant Staphylococcus aureus (MRSA), which is resistant to commonly used antibiotics.


An MRSA infection will need a specific antibiotic to treat it.


What you can do to prevent surgical site infections

Despite being the most-preventable healthcare-associated infection, the incidence of SSI has steadily increased. If you have surgery planned, there are things you can do to help prevent SSIs:

  • Tell your doctor about any medical or health problems you have, including diabetes and allergies
  • Quit smoking. Patients who smoke have a higher risk of developing an SSI
  • Don't shave near where you will be having surgery. Shaving can irritate your skin and make it easier for infections to develop.
  • Ask if you will be prescribed antibiotics prior to surgery


Why trust your non-healing surgical wound to UFAI? 

It should not be a surprise that foot and ankle pain are widespread. The American Podiatric Medical Association reports that 77% of adults have experienced foot pain, and the pain is constant for 80% of those. 


One of the great things about modern medicine is that our surgical team is well-versed in treating every part of the human body. When it comes to the often-neglected feet, it’s an orthopedic foot and ankle specialist who will keep you walking strong. That’s where we come in.


With decades of combined experience and the highest success rates in the nation, UFAI providers have treated more than 200,000 patients. We are one of the country's most technologically advanced foot and ankle practices.


UFAI’s surgeons are at the forefront of research, education, product design, regenerative medicine, and foot and ankle care advancements. Our non-profit foundation educates surgical fellows in advanced foot, ankle treatment, and surgery has performed dozens of clinical trials and has educated the community for 20 years.


Director Dr. Bob Baravarian — a Board-Certified Podiatric Foot and Ankle Specialist — is one of only a handful of foot and ankle healthcare providers to have both foot and reconstructive foot and ankle certifications as a Fellow of the American College of Foot and Ankle Surgeons.


Reference sources:

Surgical Site Infection Criteria", Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Committee on Infectious Diseases, American Academy of Pediatrics.

Veiga DF, Damasceno CAV, Veiga-Filho J, et al. Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial. Plast Reconstr Surg.2008; 122: 170e-171e

Wang ZX, Jiang CP, Cao Y, Ding YT. Systematic review and meta-analysis of triclosan-coated 

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