20. Factors to be considered in order to prevent surgical infections

Question 1

20. Factors to be considered in order to prevent surgical infections

Answer 1

Prevention of surgical infections
-primary objective of aseptic surgery
-factors to be considered
>age
>physical condition
>nutritional status
>diagnostic procedures
>concurrent metabolic disorders
>nature of the wound
>operating room practice
>characteristics of bacterial contaminants

Host factors:age
-patients older than 10 years–possible inability to mount an
appropriate immune response
-patients younger than 1 year– possible underdeveloped immune system

Host factors:physical condition,nutritional
status
-increased risk of surgical infection:
>patients with protein-calorie malnutrition
>overweight
>hypoproteinemic

Host factors:diagnostic procedures,concurrent metabolic disorders
-increased risk of infection:
>diagnostic procedures(catheterizations, centeses)
>immunosuppressive therapy
>previous antibiotic therapy
>long periods of hospitalization
>remote infections
>concurrent debilitating disorders(Cushing’s,
DM,protein-losing enteropathy)

Host factors:nature of the wound
-allowing bacterial proliferation and inhibiting normal response:
>presence of necrotic tissue
>hematoma
>serum pockets (seroma)
>local infection
>foreign bodies
>dead space

Other factors:operating room practice
-aseptic technique(also drugs [propofol])
-duration of surgery(veterinary teaching hospitals!)
>risk of infection doubling approximately every 70 minutes
-duration of anesthesia
>preparation times should be minimized
-perioperative warming if necessary
-proper atraumatic tissue handling

Other factors:characteristics of bacterial
contaminants
-nosocomial infections–caused by environmentally resistant bacteria
during hospitalization/surgery
-risk factors:
>overuse of antibiotics
>indwelling catheters
>diagnostic procedures
>advanced age
>chronic debilitating disease
-prevention–control of the hospital environment,rational AB use