A surgical site infection, or SSI, is a potential complication of any surgery. An SSI will lengthen recovery time, delay additional therapy, increase cost and potentially lead to a shorter lifespan. 

While there are some risk factors that cannot be changed, such as the use of a drain during a particular operation or the presence of a pre-existing medical condition like diabetes, there are precautions patients can take to significantly decrease their risk of an SSI.

BEFORE SURGERY:

Let your surgeon know if you have an infection somewhere else on your body. Frequent offenders are:

• Urinary tract infections
• Dental abscesses
• Skin infections, like hidradenitis
• Infected sebaceous cyst
• Previous MRSA (Methicillin Resistant Staph Aureus) infection or MRSA colonization

If possible, these infections should be treated prior to surgery, especially elective breast surgery.

Dealing with MRSA prior to surgery is critical, especially if you are planning on having breast reconstruction. Patients who are colonized with MRSA (MRSA is living on their bodies) will need to get rid of the MRSA by placing a nasal gel in their nostrils, as MRSA is frequently found inside the nose. This nasal ointment will significantly reduce the risk on an SSI by MRSA.

Use pre-operative/ pre-admission showering or cleansing soap such as Chlorhexidine (Hibiclens).

• Showering the night before and the morning of surgery using the special soap or packets will help decrease the number of infection-causing bacteria on the skin.
• Patients should make sure to concentrate the soap on the area that will be operated upon (the operative site).
• Leave the “soap” on your skin for a minute or two before rinsing off, so the antiseptic can do its job.
• No need to “scrub” the skin raw and stir up chafing. A gentle wash is fine.

Refrain from shaving the day before morning of surgery. This may cause scratches and stir up infection. Your surgeon can shave under your arm while you are in the operating room if necessary.

Refrain from placing deodorant on the morning or surgery. This can clog hair ducts and may lead to infection.

Stop smoking. This will help your body’s wound healing and decrease your risk of postoperative pneumonia.

AFTER SURGERY

Keep your surgical dressing on. Remove when instructed.

Ask your surgeon when you can shower. Find out if there are any restrictions for swimming or immersing the incisions under water, including bathing.

Do not use underarm products or body lotions on your incisions until directed by your surgeon. These lotions and potions are not sterile and premature use may lead to an SSI. And it goes without saying, no picking or scratching your incision(s).

Do not shave until you have totally normal sensation under your arm and have been cleared by your surgeon. If you have a sentinel lymph node biopsy or an axillary dissection your underarm will be numb and you will be at risk for cutting yourself while shaving with a razor. If you remain numb, a depilatory or electric razor may be used in the future.

Follow the weight and exercise instructions of your surgeon. If your wound splits apart you will be at increased risk for an SSI. Also a postoperative hematoma (collection of blood) may increase the likelihood of an SSI. Bacteria love warm, dark places with plenty of food, which is the definition of a hematoma.

Diabetics should control their blood sugars. Out of control blood sugars will increase the risk of an SSI.

If you have a drain, use sterile technique if you change the dressing. Your surgeon or nurse will instruct you. Keep the drain and dressing dry. Wash your hands before and after emptying the drain.

Signs of an SSI include:

• Redness that spreads
• Fever, with an oral temperature over 101° F
• Pain that increases significantly
• Drainage from the incision

Call your surgeon if you experience these.