From the Guidelines
No, the objects themselves do not produce TSST (Toxic Shock Syndrome Toxin-1). Toxic shock syndrome occurs when certain bacteria, primarily Staphylococcus aureus and sometimes Streptococcus pyogenes, colonize these foreign objects and produce toxins. When tampons, gauze, or sutures remain in the body for extended periods, they create an ideal environment for bacterial growth by providing a warm, moist surface with nutrients from blood or other bodily fluids. The bacteria that grow on these objects then release toxins, including TSST-1, which enter the bloodstream and trigger a massive immune response resulting in toxic shock syndrome.
Key Points to Consider
- The use of triclosan-coated sutures significantly reduces SSI prevalence compared with the non-coated sutures 1
- The application of negative-pressure wound therapy in preventing SSI may be effective in reducing postoperative wound complications and it may be an option especially in patients with a high risk of SSI 1
- Intraoperative normothermia decreases the rate of SSI, and the use of active warming devices in the operating room is useful to keep normothermia 1
Prevention of Toxic Shock Syndrome
To prevent toxic shock syndrome, it is crucial to follow recommended guidelines for tampon use (changing every 4-8 hours) and to ensure that healthcare providers carefully remove all surgical materials after procedures. People with toxic shock syndrome typically experience sudden high fever, low blood pressure, rash, and multiple organ dysfunction, requiring immediate medical attention and antibiotics to treat the underlying bacterial infection.
Importance of Evidence-Based Practice
The provided evidence highlights the importance of evidence-based practice in preventing surgical site infections and toxic shock syndrome. By following guidelines and using evidence-based practices, such as the use of triclosan-coated sutures and negative-pressure wound therapy, healthcare providers can reduce the risk of SSI and toxic shock syndrome, ultimately improving patient outcomes and reducing morbidity and mortality.
From the Research
Causes of Toxic Shock Syndrome
- Toxic shock syndrome (TSS) is a severe, toxin-mediated illness caused by Staphylococcus aureus and Streptococcus pyogenes 2, 3.
- The bacteria produce superantigenic exotoxins, such as toxic shock syndrome toxin-1 (TSST-1) and enterotoxins, which lead to rapid shock, multiple organ failure syndrome, and death 3.
- TSS can be menstrual or nonmenstrual, and sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections 2.
Role of Objects in TSS
- Leaving gauze, sutures, or tampons in for too long can increase the risk of TSS, but it is not the objects themselves that produce the toxins 4, 5.
- The toxins are produced by the bacteria, such as Staphylococcus aureus, which can colonize on the objects or in the body 3, 6.
- Tampon use has been associated with an increased risk of TSS, particularly with the use of ultra-absorbent tampons 4, 5.
Diagnosis and Treatment
- Diagnosis of TSS is based on clinical presentation, laboratory tests, and identification of the causative bacteria 2, 3.
- Treatment involves intravenous fluids, source control, and antibiotics, such as penicillinase-resistant penicillin, cephalosporin, or vancomycin, along with clindamycin or linezolid 2, 3.
- Early recognition and treatment of TSS are crucial to reduce morbidity and mortality 4, 6.