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A U E R S & T > Chapter 7 - Surgical site infection and AB > Flashcards

Chapter 7 - Surgical site infection and AB Flashcards

1
Q

What is the classification of surgical wounds? Name the 4

A
  1. clean
  2. clean-contaminated
  3. contaminated
  4. dirty
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2
Q

What was the first commercially available antibiotic?
A) Penicillin
B) Tetracycline
C) Erythromycin
D) Ciprofloxacin

A

A) Penicillin

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3
Q

Which pathogen is the most commonly reported in SSI?
A) Escherichia coli
B) MRSA
C) Enterococcus faecalis
D) Coagulase-negative staphylococci

A

B) MRSA

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4
Q

What is the infection rate reported in equine fracture repair?
A) 17.6%
B) 27.6%
C) 37.6%
D) 47.6%

A

B) 27.6%

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5
Q

What is the classification of surgical site infections name the 3 existent

A
  1. superficial incisional
  2. deep incisional
  3. organ/space
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6
Q

What was the first commercially available antibiotic?

A

Penicillin

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7
Q

Which pathogen is the most commonly reported in SSI?

A

MRSA

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8
Q

What is the infection rate reported in equine fracture repair?
A) 17.6%
B) 27.6%
C) 37.6%
D) 47.6%

A

B) 27.6%

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9
Q

What is the classification of surgical site infections name the 3 existent

A
  1. superficial incisional
  2. deep incisional
  3. organ/space
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10
Q

What type of SSI is most common in equine surgical procedures?

A

Superficial incisional

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11
Q

Describe superificial incisional describe the qualification

A

Within 30 days of operationInvolves only skin or subcutaneous tissue of the incision

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12
Q

What has to include at least?

A

purulent drainage, organism isolated in culture, 1 sign (pain, swelling, redness), diagnosis of infection by surgeon

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13
Q

qualification for deep incisional

A

Within 30 days after operation
Within 1 year if implant is in place and infection appears to be related to the operation and involves deep soft tissue (fascial and muscle layers)

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14
Q

what has to be included to be considerated deep incisional?

A

purulent drainage from deep incision but not organ space, fever, pain and abcess and dx from surgeon as deep incisional

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15
Q

define oran/sace infection

A

Within 30 days after operation if no implant
Within 1 year if implant is in place and infection appears to be related to the operation and involves any part of the anatomy (organs and spaces) other than the incision, which was opened or manipulated during the operation

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16
Q

what has to be included to be considerated organ/space?

A

purulent drainage from a drain in place through space wound in organ, abscess evident of infection on direct examination during reoperation or by histo or radio exam, diagnosis by surgeon

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17
Q

How long after closure is the surgical site resistant to microorganism entry?

A

24 hours

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18
Q

What is the most common musculoskeletal pathogen in humans and animals?

A

Staphylococcus aureus

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19
Q

What increases the risk of SSI when hair is removed too early before surgery?

A

5.6 times

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20
Q

What is the goal of laminar airflow ventilation in operating rooms?

A

To reduce microbial contamination

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21
Q

How often should the OR be cleaned to prevent contamination?

A

Daily

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22
Q

What is the recommended air exchange rate per hour in an OR?

A

15 times

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23
Q

What is the increased risk of septic arthritis following intraarticular injection when hair is removed at the injection site?

A

20 times

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24
Q

What increases the incidence of SSI by 5.6%?

A

Preoperative hair removal with a razor

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25
Q

Double gloving during surgery is recommended for:

A

Reducing contamination

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26
Q

What is a common practice in clean-contaminated and contaminated equine procedures?

A

Changing to new instruments prior to wound closure

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27
Q

Which bacteria have virulence factors for developing biofilm?

A

Staphylococcus aureus and Enterococcus faecalis

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28
Q

What is the role of SarA in Staphylococcus aureus?

A

Regulates virulence factors

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29
Q

What is the primary reason for using ultraviolet-irradiated rooms in ORs?

A

To reduce SSI

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30
Q

What characterizes a** clean elective surgical wound**?

A

Nontraumatic, uninfected, no technique break, no inflammation, no entry to respiratory, alimentary, or genitourinary tracts.

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31
Q

When is a surgical wound considered clean-contaminated?

A

When gastrointestinal or respiratory tracts are entered without significant spillage, oropharynx or vagina are entered, or there’s a minor break in technique.

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32
Q

What criteria classify a wound as contaminated?

A

Major technique break, gross spillage from the gastrointestinal tract, fresh traumatic wound, or entry into the genitourinary or biliary tract with infected urine or bile.

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33
Q

What defines a dirty wound?

A

Presence of acute bacterial inflammation, access through “clean” tissues to a pus collection, or a traumatic wound with devitalized tissues, foreign bodies, fecal contamination, or delayed treatment.

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34
Q

Does entry into the genitourinary tract with clean urine classify as clean or clean-contaminated?

A

Clean-contaminated.

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35
Q

What makes a surgical wound clean-contaminated instead of clean?

A

Entry into the gastrointestinal, respiratory, or genitourinary tract without significant spillage, or a minor technique break.

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36
Q

Is a surgical wound with no break in technique and no inflammation considered clean?

A

Yes, it is considered clean.

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37
Q

If a wound is caused by trauma less than 4 hours old, how is it classified?

A

Contaminated.

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38
Q

In what scenario would a surgical wound be classified as dirty?

A

When there is transection of “clean” tissues to access a pus collection.

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39
Q

Does encountering respiratory, alimentary, or genitourinary tracts automatically make a surgical wound clean-contaminated?

A

Not necessarily, it depends on the presence of spillage or infection and other factors.

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40
Q

How does age relate to the risk of surgical site infection (SSI) in horses?

A

Varies based on the type of surgery

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41
Q

What should be done with remote infections before elective surgical procedures?

A

Identified and treated

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42
Q

Are female horses at a greater risk of developing SSI after certain surgeries compared to males?

A

Yes

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43
Q

What is the relationship between weight and SSI in horses undergoing orthopedic procedures?

A

No direct relationship

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44
Q

What impact does malnutrition have on patients undergoing surgery?

A

Increases risk of complication

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45
Q

How does intensive glycemic control affect SSI rates?

A

Reduces the risk

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46
Q

Are neonates more susceptible to infection due to surgery compared to adults?

A

Yes

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47
Q

What is the WHO recommendation for nasal carriers of S. aureus?

A

Treatment with mupirocin ointment

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48
Q

What should be managed prior to surgery to reduce secondary SSI?

A

Any separate site of infection

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49
Q

How does age affect the risk of septic arthritis after arthroscopy in horses?

A

Younger horses tend to be at a higher risk

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50
Q

What is the risk of developing incisional site complications in horses older than 20 years?

A

17 times greater risk

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51
Q

In horses, what factors increase the likelihood of incisional complications?

A

Age and weight

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52
Q

What type of surgery is associated with an increased risk of SSI in female horses?

A

Both arthroscopic and orthopedic

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53
Q

What is a major factor in SSI development in obese human patients?

A

Reduced tissue perfusion

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54
Q

In which patient population is mupirocin decolonization limited to?

A

High-risk populations

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55
Q

Waht are the surgery-related factors that represent risk factor SSI?

A

emergency procedures, duration of sx, sx skill, foreign material and stent

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56
Q

What is the normal values of IgG levels in neonates prior to surgery?

A

> 800 mg/dL

Partial (IgG 400 to 800 mg/dL) or complete (IgG <400 mg/dL) failure of passive transfer

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57
Q

How does hypothermia affect the risk of surgical site infection (SSI)?

A

Triples it

58
Q

What is a recommended method to maintain normothermia?

A

Use heating pads and warmers

59
Q

What is the effect of supplemental oxygen on SSI risk?

A

Reduces risk

60
Q

How does skin disruption at the surgical site affect SSI rate?

A

Increases it

61
Q

What is the effect of open fractures on infection risk compared to closed fractures?

A

4.2 times higher risk

62
Q

What is the association between silk suture material and SSI?

A

3.4 times more likely to be associated with SSI

63
Q

How does stainless steel implant material affect infection rate compared to titanium?

A

Higher rate of infection

64
Q

What is the infection rate for laparoscopic procedures in horses?

A

0%

65
Q

What is the risk of SSI in closed reduction and internal fixation compared to open reduction?

A

2.5 times lower

66
Q

How does the ASA Physical Status Classification System score relate to SSI development?

A

Scores greater than 2 are associated with higher risk

67
Q

What is the recommended practice for hair removal at the surgical site?

A

Using clippers

68
Q

How should foreign material be handled in surgical sites?

A

horoughly dedebrided.

69
Q

What is the rate of SSI in equine orthopedic surgery?

A

5% to 10%

70
Q

What is the rate of SSI in equine emergency celiotomy ?

A

7.4-39%

71
Q

What is the rate of SSI in arthroscopy?

A

0.5% to 1.5%

72
Q

What is the rate of SSI in castration ?

A

2% to 3.2%

73
Q

What is the rate of SSI in laryngoplasty ?

A

0% to 4%

74
Q

What is the rate of SSI in equine ortophopedic contaminated?

A

52.6%

75
Q

What increments the risk of SII in arthroscopy?

A

draft breed and tibiotarsal joint

76
Q

Is near-far-far-near suture pattern and polygactin 910 related as risk factors for celiotomy surgery SII?

A

YES!! Lavage of linea alba, topical antibiotics to surgical site closure, incise drape for recovery, minimize surgical duration can be protective factores

77
Q

What time increments the SII infection in long bone fractures?

A

> 180 min along with open fractures configuration

78
Q

What increments the risk of laryngoplasty SII?

A

draft breed and laryngotomy

79
Q

Which agent is NOT recommended for preoperative bathing to reduce skin microflora?

A

Alcohol-based solutions

80
Q

What is recommended for reducing bacterial contamination from the hoof?

A

Trimming and soaking the hoof

81
Q

Which antiseptic has been identified as most effective at preventing SSI?

A

No single antiseptic has been identified as most effective

82
Q

What is the recommended surgical attire in the OR according to AORN guidelines?
A) Personal clothing
B) Facility-laundered scrubs
C) Disposable gowns
D) Any comfortable attire

A

Facility-laundered scrubs

83
Q

What reduces the risk of holes in surgical gloves?

A

Double gloving

84
Q

What is a key principle to minimize SSI?

A

Adhering to Halsted’s principles

85
Q

What are the halsted’s principles?

A
86
Q

What type of scalpels are recommended for skin incisions?

A

Steel scalpels

87
Q

What increases the likelihood of SSI when using suture materials?

A

Using silk sutures

88
Q

What is the effect of using surgical-steel staples for skin closure?

A

Increases risk of SSI

89
Q

However in EVE 2023 Haion Incisional complications after skin closure with stainless-steel skin staples compared to nylon sutures in horses undergoing colic surger. What was the conclusion?

A

the use of staples may serve as a valid alternative for ventral midline abdominal incision skin closure

. Pregnancy and large colon intestinal lesions were risk factors for incisional complications.

including 40% (25/63) of the surgical staples skin closure group and 46% (24/52) of the nylon suture skin closure group

90
Q

What is the role of topical antimicrobial therapy in SSI prevention?

A

Inssufficient evidence for their routine use

91
Q

What is the recommended practice for drains in surgical sites?

A

Use closed suction drains and remove them early

92
Q

What is the role of negative pressure wound therapy postoperatively?

A

Reduces SSI

93
Q

What effect does the use of triclosan-coated polyglactin 910 have in equine surgeries?

A

Associated with increased incisional edema

94
Q

What is the recommendation regarding silver-based dressings?

A

Insufficient evidence for routine use

95
Q

What percentage of equine critical care patients experience at least one nosocomial event?

A

About 20%

96
Q

What is a significant risk factor for Salmonella infection in hospitalized horses?

A

Nasogastric intubation

97
Q

How much more likely are horses undergoing exploratory celiotomy to develop nosocomial Salmonella infections?

A

2 to 8 times

98
Q

What is a clinical indicator of acute salmonellosis in horses?

A

ever greater than 39.44°C

99
Q

What factor significantly increases the risk of developing C. difficile in horses?

A

Antimicrobial therapy

100
Q

What is the rate of catheter site inflammation and infection in horses treated for gastrointestinal disease?

A

Approximately 9%

101
Q

What is the rate of nasal colonization of MRSA in veterinarians and veterinary personnel?

A

9.4% to 22.2%

102
Q

What percentage of hospital-acquired infections (HAI) are accounted for by SSI?

A

Around 20%

103
Q

By how many days does SSI, on average, extend the length of hospital stay?

A

9.7 days

104
Q

What is the estimated percentage of preventable SSIs?

A

Approximately 60%

105
Q

How long after surgery does incisional drainage typically occur, indicating SSI?

A

6 to 10 days

106
Q

What laboratory parameter is unreliable in horses for identifying an infection?

A

Complete blood counts (CBC)

107
Q

What acute phase protein peaks within 7 to 10 days of injury in horses?

A

Fibrinogen

108
Q

Which acute phase protein is a reliable indicator of real-time inflammation in horses?

A

Serum amyloid A (SAA)

109
Q

What is considered a consistent and reliable indicator of osteomyelitis in horses?

A

A plasma fibrinogen level of 900 mg/dL

110
Q

How soon does Serum Amyloid A (SAA) peak after a stimulus in horses?

A

Within 6 to 8 hours

111
Q

what does a nucleated cell count (NCC) greater than 20000 cells/µL in synovial fluid indicate?

A

Possible infection

112
Q

What percentage of synovial fluid cultures typically yield positive results?

A

64% to 89%

113
Q

Culture negative means it doesn’t have bacteria?

A

No, not correlated

114
Q

What is considered a gold standard for diagnosing Surgical Site Infection (SSI)?

A

Microbial culture

115
Q

What is the sensitivity and specificity of tissue culture compared to swab culture in diagnosing SSIs?

A

Higher sensitivity and specificity

116
Q

What is a critical step in selecting antimicrobial therapy for SSIs?

A

Determining the likely pathogen identity

117
Q

What bacteria is most commonly associated with equine orthopedic infections?

A

Staphylococcus aureus

118
Q

Which bacteria are commonly isolated in neonatal infections?

A

Escherichia coli,
Actinobacillus spp.,
and Klebsiella spp.

119
Q

What type of wounds are likely to be infected with a mixed bacterial population?

A

Penetrating wounds

120
Q

What is the first step in treating a surgical site infection (SSI)?

A

Establishing drainage of infected tissue

121
Q

What has been recognized as an important cause of implant-associated infection?

A

Biofilm

122
Q

What was Burke’s 1961 demonstration about antimicrobial prophylaxis?

A

Antibiotics before surgical incision reduce SSI

123
Q

What type of surgery does not clearly indicate the use of antibiotics according to current guidelines?

A

Arthroscopy with a low infection rate

124
Q

what is an important factor in the timing of antimicrobial administration?

A

Administering within 1 hour of surgical incision

125
Q
A
126
Q

What is the optimal drug dosing for time-dependent antimicrobials?

A

Frequent low doses

127
Q

When should additional intraoperative doses of antibiotics be administered?

A

Should be redosed 1 to 3 times the half-life of the drug from the time preoperative dose is administere

128
Q

What are β-lactam antibiotics mechanism of action?

A

Inhibit cell wall synthesis by binding proteins

128
Q

What is the impact of prolonged administration of prophylactic antibiotics?

A

Increases antibiotic resistance

129
Q

what is the risk associated with aminoglycoside use?

A

Nephrotoxicity

130
Q

What is the postantibiotic effect (PAE)?

A

Suppressed bacterial growth after antibiotic levels fall below MIC

131
Q

What are cephalosporin antibiotics mechanism of action?

A

Inhibit cell wall synthesis by binding proteins

132
Q

What are aminoglicosides antibiotics mechanism of action?

A

Inhibit protein synthesis by binding to 30S ribosomal subunit

133
Q

What are metronidazoe antibiotics mechanism of action?

A

Disrupt bacterial DNA by free radicals and unstable intermediate compound

134
Q

What are fluoroquinolones antibiotics mechanism of action?

A

Inhibit bacterial DNA gyrase

135
Q

What are trimethoprim sulfonamide antibiotics mechanism of action?

A

Synergistic action to inhibit folic acid synthesis

136
Q

What are tetracyclines antibiotics mechanism of action?

A

Inhibit protein synthesis by binding to 30S ribosomal subunit

137
Q

Which antibiotics are bacteriostatic?

A
  1. Tetracyclines
  2. Chloramhenicol
  3. Macrolides

all rest is bactericidial: penicilin, cephalosporins, aminogliscosides, fluoroquinolones, metronidazole, trimethroprim sulfonamide

138
Q

What are chloramphenicol and macrolides antibiotics mechanism of action?

A

Inhibit protein synthesis by reversibly binding to 50S ribosomal subunit

139
Q

What are the adverse effects of penicilin?

A

Autoimmune hemolytic anemia anaphylaxis,
transient hypotension,
increased large intestinal motility,
cardiac arrhythmia

140
Q

What are the adverse effects of fluoroquinolones?

A

cartilage disorders in young horses (<3y)
idiosyncratic reactions is TMPS
ototoxicityis aminoglicosides
enterocolitis is cephalosporins and metronidazole

A U E R S & T (121 decks)

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