Be Alert And Recognize IDO, An Infection That Can Occur After Surgery

Illustration (Photo: Antara)

JAKARTA - Consultant Surgeon Digestive Surgeon who is also a member of the Indonesian Doctors Association (IDI) Dr. dr. Warsinggih, Sp.B-KBD, reminded to be aware of the Operation Area Infection (IDO) that may occur after surgery.

He said, SSI is an infection that occurs in the surgical area within 30 days post-surgery, even 1-year post-surgery if surgery uses implants.

"The infection occurred in an area that had been operated on. In fact, the operation was not carried out because of an infectious disease. For example an accident, it was originally a clean area," said doctor Warsinggih, as quoted by Antara, Saturday, October 30.

In general, according to Doctor Warsinggih, SSI is characterized by several conditions such as redness and swelling around the stitches, discharge of pus or blood, and is often accompanied by excruciating pain.

"Then the feeling of warmth in the area of the surgical wound and swelling. Usually sometimes to have a fever," he added.

Furthermore, he explained that SSI is classified into three types, namely superficial, deep, and organ or cavity.

Superficial is a type of SSI that is limited to the skin and subcutaneous tissue. Deep, if the infection affects the deeper layers to the muscles, while the organ or cavity if the infection has reached the organ or is in the form of a cavity.

Consultant neurosurgeon specialist and chairman of the Indonesian Surgical Specialist Association (IKABI) dr. Andi Asadul Islam, Sp.BS(K), added that if the SSI is wide or deep, especially if the patient uses implants, the condition will be more dangerous.

"It is dangerous if it is deep, especially if there is an implant used. Infections on the skin that are initially only external, can spread to the implant. If it is infected with the implant, the implant must be removed. That is the most troublesome thing," he said.

He also said that in addition to worsening the patient's condition, SSI can also cause additional treatment costs and the threat of increasing antibiotic resistance and even death.

"IDO causes three times higher mortality. The cost burden is also higher because of the longer duration of hospitalization and the need for additional medical interventions such as reoperation," said doctor Andi.

Cause of SID

The risk factors for SSI, said Doctor Warsinggih, can come from the patient's condition, operating environment factors, and microorganism factors.

From the patient's condition factors, SSI may occur if you suffer from hyperglycemia (high levels of glucose in the blood), poor nutrition, obesity, impaired circulation ischemia (lack of oxygen supply to organs or tissues), hypoxia (lack of oxygen in the tissues), and hypothermia (body temperature). The low one).

In obese patients, doctors Warsinggih said the risk of SSI can increase up to 4 times. This is because the increase in fat mass in the body can cause a weak immune system so that it is vulnerable to infection.

"Obesity is a major risk factor for a number of diseases that can affect the success of the operation," said Doctor Warsinggih.

While the operating environment factors include surgical personnel and emergency operations, while microorganism factors include resistant bacteria.

In the operating room environment, said Doctor Warsinggih, surgical personnel should be minimized to reduce the incidence of SSI.

"This has also been regulated in IDO's Clinical Practice Guidelines (CPG) that a maximum of 10 personnel in the operating room is expected and it is hoped that no one will walk around," he said.

Regarding the recommendations made in the CPG IDO, Dr. Warsinggih said that efforts to reduce the incidence of SSI can be done from preoperative, intraoperative, and postoperative.

During pre-surgery, said doctor Warsinggih, CPG recommends keeping the operating area clean by bathing with soap 24 hours before surgery. If shaving is required, it is performed in the operating room using a clipper.

The administration of antibiotics, he continued, is carried out with the right indications following the pattern of germs that occur in the hospital, at the right time, in the right dose, and in the right route.

Then, all surgical specialists involved in postoperative wound care must understand and supervise the wound healing process including the selection of postoperative dressings.

Regarding postoperative wound care, Dr. Warsinggih emphasized the importance of explaining to the patient or his family how to maintain the condition of the surgical wound properly.

Post-operative wound care tips

The following are some tips that can be done in postoperative wound care so that SSI does not occur.

First, carefully follow the instructions for using the drug given by the doctor. Be careful with drugs that are consumed without a doctor's instructions because they can cause unwanted side effects.

Second, take care of yourself by consuming nutritious food and drinks, as well as maintaining personal hygiene.

"After surgery, we need more protein, less fat, and carbohydrates. It would be better if we consult a nutritionist," said doctor Andi.

Third, don't miss the next control schedule. Always pay attention to the control schedule and come according to the specified date.

If you are doing postoperative wound care at home, do not peel the itchy or dry area and shower after 48 hours postoperatively if the wound is covered with a waterproof dressing.

If you can change the dressing yourself, wash your hands with soap and don't touch the wound area. Apply the dressing or bandage carefully, do not touch the inside of the bandage, and do not apply antiseptic cream under the bandage.

If there is any suspicion of a wound such as increasing pain or emitting an unpleasant odor, do not hesitate to consult a doctor immediately.

Doctor Andi said that the incidence of SSI is still a serious problem and full of challenges for surgeons, especially in developing countries, and is a significant cause of morbidity and mortality after surgery.

Citing a report from Cipto Mangunkusumo Hospital in 2013, doctor Andi said the incidence of SSI in abdominal surgery was 7.2 percent and in 2020 it was reported to be 3.4 percent. However, he assessed that the data on IDO incident reporting in Indonesia still needed to be improved.

To reduce the incidence of SSI in Indonesia, IKABI on Thursday launched CPG IDO to harmonize perceptions and uniformity of surgical management.