Antibiotic Prophylaxis and Sepsis Flashcards
what does a superficial incisional infection affect?
the skin and subcutaneous tissue of the surgical incision
what does the onset tend to be for a superficial incisional infection?
within 30 days after surgery
what are the signs and symptoms of a superficial incisional infection?
5 signs of swelling +/- purulent fluid at the site of incision
what does a deep incisional infection affect?
skin, subcutaneous tissue, and deep soft tissue (fascial and muscle)
what does the onset tend to be for a deep soft incisional infection or an organ/space infection?
within 30 days after surgery or within a year if an implant is in place
what are the signs and symptoms of a deep incisional infection?
- purulent fluid at site of infection
- fever and localised tenderness
- abscess formation
what does an organ/space infection affect?
skin, subcutaneous tissue, deep soft tissue, any organ or anatomy that was manipulated in the procedure
what are the signs and symptoms of an organ/space infection?
- purulent fluid at site of infection
- systemic signs of infection
- abscess formation
what are the two most common infectious organisms for an incisional infections?
- staphylococcus aureus
- e. coli
what are patient risk factors for a surgical site infection?
- extreme age
- obese or malnourished
- diabetic
- smoking
- immunosuppression
what are surgical risk factors for a surgical site infection?
- preoperative skin preparation
- length of operation
- antibiotic prophylaxis
- instrument sterilisation
- surgical drains
- post-operative hypothermia
what key measures are taken in the pre-operative phase to prevent surgical site infections?
- pre-operative showering and hair removal
- antibiotic prophylaxis or treatment if patient had prior infection
what measures are taken in the intra-operative phase to prevent surgical site infections?
- surgical scrubbing
- sterile equipment including clothing
- antiseptic skin prep
- oxygenation and laminar airflow in theatre
what measures are taken in the post-operative phase to prevent surgical site infections?
- regular dressing changes using an aseptic technique
what patients are considered high risk for MRSA infections?
- surgical patients
- ITU patients
- patients with a central venous catheter
- patients with known MRSA carriage
what patients are considered medium risk for MRSA infections?
all adults are considered medium risk
what patients are considered low risk for MRSA infection?
all children are considered low risk
what treatment is given to high risk MRSA patients?
- screen for MRSA on admission
- give nasal mupirocin and disinfectant body wash throughout stay
what treatment is given to medium risk MRSA patients?
disinfectant body wash throughout their stay
what is the treatment for low risk MRSA patients?
no specific action is given
what is the standard antibiotic prophylaxis treatment given before lower abdominal and hepatobiliary surgery?
metronidazole 500mg IV
gentamicin 120mg IV
what is the standard antibiotic prophylaxis treatment given before upper abdominal surgery?
co-amoxiclav 1.2g IV
what other drug is given in antibiotic prophylaxis if the patient is MRSA positive?
teicoplanin 400mg IV
true or false: co-amoxiclav is safe to give to patients with a penicillin allergy
false.
patients should instead be treated with gentamicin 120mg IV and metronidazole 500mg IV
what is the antibiotic prophylaxis treatment before orthopaedic surgery?
co-amoxiclav 1.2g IV
what is sepsis?
a life-threatening organ dysfunction caused by an abnormal and uncontrolled host response to an infection
what is a SOFA score?
a way for clinicians to identify the extent of organ dysfunction
what SOFA score would indicate sepsis?
a score equal or more than 2
what levels are looked at to determine a qSOFA score?
- respiratory rate >22/min
- altered mental state
- systolic BP <100mmHg
what is involved in the sepsis 6 bundle?
mnemonic: BUFALO or 'Give 3 Take 3' Bloods (culture) Urine output Fluids Antibiotics Lactate Oxygen
what are the common sources of sepsis on the wards?
‘The 7 Cs’:
Chest infection, Cut, Catheter, Collections (abdomen/pelvis), Calves (DVT), Cannula, Central line
what is classified as septic shock?
sepsis with hypotension despite adequate fluid resuscitation
