Signs of an Infection After Surgery

Whether you’re having breast reconstruction surgery, knee replacement surgery or heart surgery, an infection of a surgical wound is serious business. And in some cases, an infection after surgery can be life-threatening.

Before and after your surgery, your healthcare team will take precautions to keep your incision area clean and free from bacteria that can lead to an infection (Staphylococcus, Streptococcus and Pseudomonas are common culprits). In most cases, your surgeon will close the site with stitches, staples or Steri-Strips and then apply a dressing over the area.

But once you’re home, what can you do to reduce your risk of an infection? And what signs or symptoms of an infection should you be looking for?

Cardiothoracic surgeon Nicholas Smedira, MD, shares the steps you can take to decrease the chances of a post-operative wound infection.

Are infections common?

Infections after surgery are uncommon — about 1% to 3% of people develop surgical site infections (SSIs). In fact, SSIs account for 20% of all hospital-acquired infections.

SSIs can be classified into three different groups:

• Superficial incisional SSIs: This type of infection happens around the incision site.
• Deep incisional SSIs: This type of infection can be found under your incision and affects your muscles and tissues near the area.
• Open or space SSIs: This is when an infection occurs in other areas of your body such as your organs.

Dr. Smedira also says that certain individuals have a greater risk of developing an infection after surgery. Those include:

• People who are older than 65 years.
• People who are immunocompromised.
• People who smoke.
• People who have overweight/obesity.
• People who have diabetes.
• People who’ve had a recent emergency surgery or a long surgical procedure.

Signs of an infection after surgery

Once you’re home, you’ll want to monitor your incision for any signs of infection. After surgery infection signs can include:

• Discharge or pus. You may notice that your wound has a thicky, cloudy, white or cream discharge or pus.
• A bad odor. You may notice an unpleasant smell coming from the incision site.
• A change in the color of your skin. This can include redness that goes beyond the incision.
• A change to the size of your incision site. An infection can make your incision line deeper, longer or wider.
• A hot incision. You may notice a warm temperature around the surgical site.
• A fever that’s greater than 101 degrees Fahrenheit (38.33 degrees Celsius). This can be accompanied by sweating and chills.
• Pain and tenderness. Your incision site and the surrounding areas can be painful or tender.

How to prevent an infection after surgery

There are things your doctor will do to help decrease the risks of post-operative wound infections. But there are also steps you can take to help yourself. Dr. Smedira recommends the following:

Follow pre-surgery recommendations or instructions

You have a greater risk of developing an infection if you have overweight or obesity. Your doctor may recommend getting to a weight that’s healthy for you before an elective surgery.

If you have diabetes, you’ll want to get your blood sugar well-managed as much as possible. In the weeks leading up to your surgery, monitor your blood sugars (up to four times per day), drink plenty of fluids and call your provider if your blood sugars are consistently over 250.

“The better controlled your blood sugars are before surgery, the lower your risk of developing an infection,” stresses Dr. Smedira.

And if you smoke, you should stop smoking a few days before your surgery and while your incision heals.

Have a conversation about hair removal

You may be tempted to remove any hair on, near or around the planned surgical site before your surgery.

Dr. Smedira says it’s best to leave it to the professionals. During surgery prep, your surgical team may remove the hair on your body where the surgeon will make the skin incision.

“Timing is important here,” he stresses. “The team should take care to remove the hair right before the surgeon makes the skin incision. If they remove the hair too far in advance, you can develop infections in the small cuts that occur with any hair removal.”

And there’s been some debate, including this meta-analysis, on whether hair removal is necessary or increases your chances of SSIs. How it’s removed can also play a role.

“Recent studies show that clippers are generally safer than razors,” Dr. Smedira continues. “Razors increase the risk of surgical site infections.”

Make sure to talk to your surgeon about hair removal and if it’s necessary, making sure to voice any concerns or questions.

Take antibiotics

An hour before surgery, your surgical team may give you a “prophylactic” or preventive antibiotic. In fact, you’ll receive antibiotics intravenously both before and after your surgery. With these steps, you’re less likely to get a wound infection.

While you may think you need antibiotics once you’re home and recovering, they’re typically not used because overuse of antibiotics can lead to resistance.

Take care of your wound

Before the surgical team discharges you from the hospital, they’ll teach you how to care for your wound. That’s critical in preventing a wound infection. You’ll receive discharge instructions, so be sure you understand them and ask questions if you don’t.

Whether you have large incisions or a minimally invasive, smaller incision, carefully monitor all of your wound sites to watch out for infection. Make sure your hands are clean when you check your wounds.

Always follow your care team’s instructions for bathing and showering — instructions may vary depending on how the incision was closed (staples, stitches, tissue adhesive, Steri-Strips).

What happens if you think you have an infection?

While SSIs are uncommon, they can happen. And they can happen anywhere from the first few days after surgery up until the wound heals. So, you need to be vigilant about keeping the incision area clean.

Infections can spread to your bloodstream and result in septicemia and even septic shock.

“If you suspect you may have an infection after your surgery and are experiencing any symptoms like a fever and pain and notice a change in the appearance of your incision site, don’t hesitate to contact your doctor,” stresses Dr. Smedira.