Surgical site infection recognition

The European Wound Management Association (EWMA) recommendations for the early recognition of surgical site infection are:1

General issues: Practice points:

It is important to recognise when the normal inflammatory process becomes abnormal and when this is due to infection

Any redness/inflammation around the wound lasting several days should be a cause for concern, particularly if the inflamed skin is warmer than the surrounding area and painful to touch

The level of suspicion should be raised if more than one indicator of infection is present

Pain that begins or increases around the wound area in conjunction with other signs of inflammation/erythema several days after surgery is of concern

The presence of pus in whatever form is an immediate indicator of infection, although this may be difficult to identify

Any discharge from the wound 48 hours after surgery requires further investigation. Offensive smelling discharge is a clearer indication of infection. Discharge due to infection is most common around 5-10 days post surgery

When wounds simply fail to heal or where there are disturbances to the normal healing process, further investigation is required

Reasons other than infection for disturbances in the normal healing process should be excluded prior to a diagnosis of infection (i.e. poor suturing, etc.)

To define infection use validated tools

Consistent application of any scoring system or tool is required

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