Chapter 26- Surgical Infection- Wound/Surgical Site Infection Flashcards

1
Q

What is it?

A

Infection in an operative wound

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2
Q

When do these infections arise?

A

Classically, PODs #5 to #7

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3
Q

What are the signs/symptoms?

A
  • Pain at incision site
  • erythema
  • drainage
  • induration
  • warm skin
  • fever
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4
Q

What is the treatment?

A
  • Remove skin sutures/staples
  • rule out fascial dehiscence
  • pack wound open
  • send wound culture
  • administer antibiotics
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5
Q

What are the most common bacteria found in postoperative wound infections?

A
  • S. aureus (20%)
  • E. coli (10%)
  • Enterococcus (10%)
  • Other causes:
    • Staphylococcus epidermidis
    • Pseudomonas
    • anaerobes
    • other gram-negative organisms
    • Streptococcus
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6
Q

Which bacteria causes fever and wound infection in the first 24 hours after surgery?

A
  • Streptococcus
  • Clostridium (bronze-brown weeping tender wound)
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7
Q

What is a “clean” wound?

A

Elective, nontraumatic wound without acute inflammation; usually closed primarily without the use of drains

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8
Q

What is the infection rate of a clean wound?

A

<1.5%

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9
Q

What is a clean-contaminated wound?

A

Operation on the GI or respiratory tract without unusual contamination or entry into the biliary or urinary tract

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10
Q

Without infection present, what is the infection rate of a clean-contaminated wound?

A

<3%

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11
Q

What is a contaminated wound?

A
  • Acute inflammation
  • traumatic wound
  • GI tract spillage
  • or a major break in sterile technique
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12
Q

What is the infection rate of a contaminated wound?

A

≈5%

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13
Q

What is a dirty wound?

A
  • Pus present
  • perforated viscus
  • or dirty traumatic wound
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14
Q

What is the infection rate of a dirty wound?

A

≈33%

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15
Q

What factors influence the development of infections?

A
  • Foreign body (e.g., suture, drains, grafts)
  • Decreased blood flow (poor delivery of PMNs and antibiotics)
  • Strangulation of tissues with excessively tight sutures
  • Necrotic tissue or excessive local tissue destruction (e.g., too much Bovie)
  • Long operations (>2 hrs)
  • Hypothermia in O.R.
  • Hematomas or seromas
  • Dead space that prevents the delivery of phagocytic cells to bacterial foci
  • Poor approximation of tissues
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16
Q

What is the treatment?

A
  • Incision and drainage—an abscess must be drained (Note: fluctuation is a sign ofa subcutaneous abscess; most abdominal abscesses are drained percutaneously)
  • Antibiotics for deep abscesses
17
Q

What are the indications for antibiotics after drainage of a subcutaneous abscess?

A
  • Diabetes mellitus
  • surrounding cellulitis
  • prosthetic heart valve
  • or animmunocompromised state