Chapter 26- Surgical Infection- Wound/Surgical Site Infection Flashcards
What is it?
Infection in an operative wound
When do these infections arise?
Classically, PODs #5 to #7
What are the signs/symptoms?
- Pain at incision site
- erythema
- drainage
- induration
- warm skin
- fever
What is the treatment?
- Remove skin sutures/staples
- rule out fascial dehiscence
- pack wound open
- send wound culture
- administer antibiotics
What are the most common bacteria found in postoperative wound infections?
- S. aureus (20%)
- E. coli (10%)
- Enterococcus (10%)
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Other causes:
- Staphylococcus epidermidis
- Pseudomonas
- anaerobes
- other gram-negative organisms
- Streptococcus
Which bacteria causes fever and wound infection in the first 24 hours after surgery?
- Streptococcus
- Clostridium (bronze-brown weeping tender wound)
What is a “clean” wound?
Elective, nontraumatic wound without acute inflammation; usually closed primarily without the use of drains
What is the infection rate of a clean wound?
<1.5%
What is a clean-contaminated wound?
Operation on the GI or respiratory tract without unusual contamination or entry into the biliary or urinary tract
Without infection present, what is the infection rate of a clean-contaminated wound?
<3%
What is a contaminated wound?
- Acute inflammation
- traumatic wound
- GI tract spillage
- or a major break in sterile technique
What is the infection rate of a contaminated wound?
≈5%
What is a dirty wound?
- Pus present
- perforated viscus
- or dirty traumatic wound
What is the infection rate of a dirty wound?
≈33%
What factors influence the development of infections?
- 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