co-existing 26 & 27 Flashcards
risk factors for surgical site infection
patient related factors
extremes of age poor nutritional status asa > 2 diabetes mellitus smoking obesity co-existing infections colonization immunocompromised longer preoperative hospital stay
risk factors for surgical site infection
microbial factors
enzyme production
polysaccharide capsule
ability to bind to fibronectin
biofil and slime formation
risk factors for surgical site infection
wound related factors
devitalized tissue dead space hematoma contaminated surgery presence of foreign material
SSI rate for extrabdominal surgery
2-5%
SSI rate for intrabdominal srugery
20%
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
14-16%
60% ICU time
5 times more likely for readmission
what “bug” is the predominant cause of SSI
MRSA
how many days within surgery do SSI present
30 days
significant alcohol consumption preop results in
immunocompromise
muprocin to nares
successful in eliminating carrier state of S Aureus
concern may promote resistance
hair clip or shave
Hair clip- shaving increases risk of SSI- due to micro cuts
preop skin cleanse with
chlorhexidine
timing of abx
1 hours prior to incision
if surgery greater than 4 hours- may necessitate a second dose
discontinue propholaxysis within
24 hours
48 hours cardiac
surgical infection prevention guidelines
1-7
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
Superficial incisional SSI
within 30 days of surgery
superficial pus drainage
organisms cultured from superficial tissue or fluid
signs and symptoms -pain, redness, swelling, heat
deep incisional SSI
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)
organ/space SSI
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
what does hypothermia do to the incidence of SSI
increase the incidence of SSI
oxygen tension and SSI incidence
up to 80% decreases SSI(controversial)
analgesia and and SSI incidence
superior treatment of surgical pain is associated with decrease incidence of SSI
It is considered a BSI Signs and symptoms develop within how many hours
48hrs
common pathogens associated with blood stream infection
gram positive bacteria (59%)
- coagulase-negative staphylococci
- staphlyoccus aureus
- enterococci
- streptococus pneumoniae
common pathogens associated with BSI
gram negative bacteria (31)%
systemic inflammatory response syndrome (SIRS)
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