co-existing 26 & 27 Flashcards

1
Q

risk factors for surgical site infection

patient related factors

A
extremes of age
poor nutritional status
asa > 2
diabetes mellitus
smoking
obesity
co-existing infections
colonization
immunocompromised
longer preoperative hospital stay
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2
Q

risk factors for surgical site infection

microbial factors

A

enzyme production
polysaccharide capsule
ability to bind to fibronectin
biofil and slime formation

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3
Q

risk factors for surgical site infection

wound related factors

A
devitalized tissue
dead space
hematoma
contaminated surgery
presence of foreign material
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4
Q

SSI rate for extrabdominal surgery

A

2-5%

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5
Q

SSI rate for intrabdominal srugery

A

20%

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6
Q

out of nosocomial infections what percent is SSI

rendering patients % more likely to spend time in ICU

5 times more likely to…

twice as likely to die

A

14-16%

60% ICU time

5 times more likely for readmission

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7
Q

what “bug” is the predominant cause of SSI

A

MRSA

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8
Q

how many days within surgery do SSI present

A

30 days

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9
Q

significant alcohol consumption preop results in

A

immunocompromise

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10
Q

muprocin to nares

A

successful in eliminating carrier state of S Aureus

concern may promote resistance

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11
Q

hair clip or shave

A

Hair clip- shaving increases risk of SSI- due to micro cuts

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12
Q

preop skin cleanse with

A

chlorhexidine

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13
Q

timing of abx

A

1 hours prior to incision

if surgery greater than 4 hours- may necessitate a second dose

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14
Q

discontinue propholaxysis within

A

24 hours

48 hours cardiac

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15
Q

surgical infection prevention guidelines

1-7

A

abs within 1 hours of surgical incision
stop at 24 hours or 48 hours- cardiac
increase dose of abs for larger patients
repeat dose when surgery exceeds 4 hours
administer appropriate for local resistance patterns
follow aha guidelines for patients at risk for infective endocarditis
adhere to procedure specific antibiotic recommendations

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16
Q

Superficial incisional SSI

A

within 30 days of surgery

superficial pus drainage
organisms cultured from superficial tissue or fluid
signs and symptoms -pain, redness, swelling, heat

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17
Q

deep incisional SSI

A

within 30 days of surgery or 1 year if prosthetic implant present

deep pus drainage
dehiscence or wound opened by surgeon (temp greater 38, pain tenderness)
abscess (radiographically diagnosed)

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18
Q

organ/space SSI

A

within 30 days of surgery or within 1 year of prosthetic implant present

pus from drain in the organ/space
organisms cultured from ascetically obtained specimens or fluid or tissue in the organ/space
abscess involving the organ/space

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19
Q

what does hypothermia do to the incidence of SSI

A

increase the incidence of SSI

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20
Q

oxygen tension and SSI incidence

A

up to 80% decreases SSI(controversial)

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21
Q

analgesia and and SSI incidence

A

superior treatment of surgical pain is associated with decrease incidence of SSI

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22
Q

It is considered a BSI Signs and symptoms develop within how many hours

A

48hrs

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23
Q

common pathogens associated with blood stream infection

A

gram positive bacteria (59%)

  • coagulase-negative staphylococci
  • staphlyoccus aureus
  • enterococci
  • streptococus pneumoniae
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24
Q

common pathogens associated with BSI

A

gram negative bacteria (31)%

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25
Q

systemic inflammatory response syndrome (SIRS)

A

diagnosis must have two or more

WBC greater 12,000
10%bands
heart rate great 90
temp greater than 38 or less than 36
respiratory rate greater than 20 or paco2 less than 32
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26
Q

sepsis goals

A
map 65
cvp 8-12
adequate urine output
with out lactic acidosis
mixed svo2 above 70%
27
Q

antibiotic therapy most commonly associated with C difficile infection

A
clindamycin
fluoroquinolones
cephalosporins, carbapenems, monobactams
macrolides
sulfonamides
pCN
tetracyclines
28
Q

largest transmission category of HIV

A

men who have sex with men 63%

29
Q

second largest transmission category of HIV

A

heterosexual sex twice as many women as men get infected 25%

30
Q

what percent of HIV patients have abnormal echo

A

50%

31
Q

pericardial effusion is present in

A

25%

32
Q

what asa status do HIV /AIDS patient get without any clinical evidence of deterioration

A

asa 2

33
Q

depending on severity of diseases and coexisting disease what asa might hiv/aids gets

A

asa3-4

34
Q

does having hiv/aids increase post surgical complicaitons

A

no

35
Q

what is commonly seen during anesthesia with HIV patitns

A

tachycardia.

36
Q

what is commonly seen postop

A

fever anemia and tachycardia are more frequent

37
Q

HIV positive parturient can they get epidurals

A

yes and blood patches

38
Q

innate immunity

A

passed on through the generations-

39
Q

acquired immunity (adaptive immunity)

A

more mature system - delayed onset of action.

40
Q

immune dysfunction - tell me the three types

A

inadequate immune response
excessive immune response
misdirected immune response

41
Q

who has more neutrophils

who has less

A

new borns have a higher granulocyte count

african americans have a lower granulocyte count

42
Q

kostmann syndrome

A

inhibits neutrophil maturation

43
Q

name drugs associated with neutropenia

A

chloramphenicol, antithyroid meds, analgesia, TCA’s

any drug can produce severe life threatening neutropenia

44
Q

alcoholics have decreased neutropenia

A

ethanol toxic effects on marrow precursor cell compromise.

45
Q

two most common causes of antineutrophil antibodies

A

SLE & RA

46
Q

leukocyte adhesion deficiency

A

higher risk of recurrent bacterial infections

47
Q

chediak-higashi syndrome

A

albinism, frequent bacterial infections, mild bleeding diathesis, progressive neuropathy, cranial nerve defects- WBC destroyed before leaving the bone marrow

48
Q

neutrophil-specific granule deficiency syndrome

A

impaired chemotaxis and bactericidal activity

frequent bacterial and fungi infections

49
Q

G-CSF

A

granulocyte stimulating factor

beneficial for HIV patients- beneficial for neutropenic patients under going elective surgery

50
Q

what activates the complement system

A

patogen dependent (classical)

pathogen -independent (alternative)

51
Q

how does the complement system work

A

it coats the bacterial in protein to facilitate phagocytosis.

52
Q

what is the primary organ for complement synthesis

A

liver

53
Q

deficiency of C1 esterase inhibitor is responsible for

A

hereditary angioedema

54
Q

patients receiving prednisone, stress, exposure to certain drugs and smoking have what?

A

granylocytosis

55
Q

what is not useful in the treatment of acute angioedema

A

androgens catecholamines antihistamines and antkbibrinolytsi are not useful

56
Q

iga deficiency

A

recurrent sinus and pulmonary infections

will experience anaphylaxis if exposed to iga

57
Q

cold autoimmune diseases

A

igm and iga antibodies agglutinate in response to temp less than 33

58
Q

macroglossia featured during amyloidosis

A

large tongue- cardiac dysfunction

59
Q

DIGEORGE syndrome

A

diminished or absent thymus gland

60
Q

latex response vs drug response

A

30 mintes

drugs 5-10min

61
Q

does cross senesitivity exist between muscle relaxants

A

yes

62
Q

abs cross sensitivity

A

very low

63
Q

most common drugs for allergy

A

muscle relaxants
antibiotics- b lactam drugs, sulfonamides, vancomycin, quinolone
latex