Recognising Surgical Site Infection for Student Nurses
Learn how to recognise changes that may indicate a surgical site infection, assess the wound alongside the whole patient and understand when concerns require prompt escalation.
What is a surgical site infection?
A surgical site infection can develop following an operation and may involve the incision or deeper tissues. Student nurses are not expected to diagnose infection independently, but they play an important role in noticing changes, documenting findings and escalating concerns.
Look at the wound
Observe for new or increasing redness, swelling, warmth, drainage, wound-edge changes or other deterioration.
Listen to the patient
Increasing pain, tenderness or feeling generally unwell may add to concern when combined with wound changes.
Assess the whole patient
Temperature and other physiological observations help determine whether concern extends beyond the wound.
Changes around the surgical wound
| Finding | What you may notice | Why it matters |
|---|---|---|
| Redness | Redness develops or appears to extend beyond the area previously documented. | Progressive change should be assessed alongside other wound and patient findings. |
| Swelling | Tissue surrounding the incision becomes increasingly swollen. | New swelling may add to concern when combined with pain, warmth or drainage. |
| Warmth | The surrounding area feels warmer than expected. | Warmth alone is nonspecific, so assess it as part of the overall pattern. |
| Drainage | The amount, colour, consistency or character of wound fluid changes. | New or significantly changed drainage requires appropriate assessment. |
| Pain | Pain becomes more severe, changes in character or increases after previously improving. | A changing pain pattern may indicate that wound healing requires reassessment. |
| Wound edges | The incision appears to be opening or healing differently from previous assessment. | Wound separation requires prompt qualified assessment. |
Assess more than the incision
Compare with baseline
Review previous wound documentation and identify what has changed since the last assessment.
Assess local findings
Observe the wound, wound edges, drainage and surrounding skin according to local wound-care procedures.
Ask about symptoms
Consider pain, tenderness, chills, feeling unwell and any other relevant changes reported by the patient.
Assess the patient
Review temperature and other observations and consider whether the patient's overall condition has changed.
One sign is not the whole diagnosis
Some redness, discomfort or drainage may occur during wound healing. Clinical concern increases when findings are new, worsening, unexpected or occur together.
New wound redness
Establish whether it is increasing, spreading or accompanied by other changes.
Pain is getting worse
Compare with earlier pain assessments and the expected pattern of recovery.
Temperature has risen
Connect this with the wound findings, observations and general clinical condition.
When the problem may extend beyond the wound
A patient with wound changes may also develop signs of wider illness. This should shift your focus from a local wound review to whole-patient assessment.
- Fever or significant temperature change.
- Increasing respiratory rate.
- Increasing pulse rate.
- Changing blood pressure or peripheral perfusion.
- New confusion or reduced responsiveness.
- Reduced urine output.
- Increasing weakness or a patient who appears increasingly unwell.
Reduce unnecessary contamination
Surgical wound care should follow local infection-prevention procedures, the patient's wound-management plan and the required aseptic technique.
Perform hand hygiene
Follow the required hand-hygiene procedure before and after wound care.
Use the required aseptic approach
Follow local ANTT or other approved wound-care procedure according to the clinical situation.
Protect key parts and sites
Prepare equipment appropriately and avoid unnecessary contact with areas that must remain aseptic.
When should you escalate concern?
- Rapidly worsening redness, swelling or wound appearance.
- New or substantially increased wound drainage.
- Unexpected wound separation.
- Increasing or unusually severe pain.
- Significant bleeding.
- Fever or other systemic symptoms with wound changes.
- New confusion, drowsiness or physiological deterioration.
- Any situation in which the patient appears acutely unwell.
βThe wound is more painful todayβ
Example
A patient is five days after surgery. Yesterday their wound was documented as clean and their discomfort was improving.
Today they report noticeably increased pain. You observe increasing redness around part of the incision and new wound drainage. Their temperature has also risen.
You recognise the pattern: increasing pain + changing wound appearance + new drainage + temperature change.
You assess the patient's wider condition and promptly communicate your concerns to the registered nurse.
Describe the evidence, not just the label
Example escalation
βI'm concerned about Mr Jones's surgical wound. His pain has increased since yesterday, the redness around the incision has increased and there is new drainage. His temperature is also higher than on the previous observations.β
This is more useful than simply saying, βI think the wound is infected,β because it communicates the actual changes that prompted your concern.
Errors to avoid
- Diagnosing infection from redness alone.
- Looking at the wound without assessing the patient.
- Ignoring a new increase in wound pain.
- Changing a dressing without noticing changes in drainage.
- Failing to compare the wound with previous documentation.
- Using wound-care techniques outside local policy or competence.
- Waiting for severe systemic deterioration before escalating a concerning pattern.
Local β symptoms β systemic β escalate
Recognise the pattern, not just the wound
Strong wound assessment combines local changes with symptoms, physiological observations and the patient's overall condition.
Explore Clinical Confidence β