Infection

The skin is the body’s first line of defense against infection. During surgery this
line of defense is penetrated. Even though the surgical procedure is performed in
as aseptic an environment as possible, the possibility of infection still exists.

WHAT WENT WRONG?
Wound infections can develop in the postoperative period. The wound may be
contaminated before surgery, such as with penetrating trauma, or may become
infected during healing. The surface of the skin has bacteria that are naturally
present, referred to as normal flora. These bacteria may enter the wound and cause
infection. Nosocomial infections can also occur at the surgical site, caused by
bacteria found elsewhere in the hospital. Infection within the surgical wound will
slow approximation of the wound edges, delaying wound healing.

SIGNS AND SYMPTOMS

• Increase in pain at surgical wound due to inflammatory process early in
infection
• Redness at wound edges that spreads if untreated
• Drainage from wound site due to body’s response to bacterial presence (change
in color and odor of drainage)
• Fever due to infection
• Elevated white blood cell count

TEST RESULTS

• Elevated WBC due to body’s response to bacterial presence.
• Elevated erythrocyte sedementation rate due to inflammation.
• Culture of wound area will identify organism.
• Sensitivity test will identify appropriate antibiotic treatment.

TREATMENT
• Obtain culture and sensitivity test of wound.
• Administer appropriate antibiotics intravenously.
• Keep wound site clean and dry.

NURSING DIAGNOSES
• Risk for infection
• Impaired skin integrity
• Impaired tissue integrity
• Delayed surgical recovery

NURSING INTERVENTIONS
• Monitor vital signs; look for fever.
• Assess surgical wound for redness, drainage.
• Ask patient about pain at surgical site.
• When obtaining wound culture, remove surface drainage with gauze, then
obtain specimen from within wound edge (this will ensure that the organism
is actually from the wound and not from the skin).