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
sepsis goals
map 65 cvp 8-12 adequate urine output with out lactic acidosis mixed svo2 above 70%
antibiotic therapy most commonly associated with C difficile infection
clindamycin fluoroquinolones cephalosporins, carbapenems, monobactams macrolides sulfonamides pCN tetracyclines
largest transmission category of HIV
men who have sex with men 63%
second largest transmission category of HIV
heterosexual sex twice as many women as men get infected 25%
what percent of HIV patients have abnormal echo
50%
pericardial effusion is present in
25%
what asa status do HIV /AIDS patient get without any clinical evidence of deterioration
asa 2
depending on severity of diseases and coexisting disease what asa might hiv/aids gets
asa3-4
does having hiv/aids increase post surgical complicaitons
no
what is commonly seen during anesthesia with HIV patitns
tachycardia.
what is commonly seen postop
fever anemia and tachycardia are more frequent
HIV positive parturient can they get epidurals
yes and blood patches
innate immunity
passed on through the generations-
acquired immunity (adaptive immunity)
more mature system - delayed onset of action.
immune dysfunction - tell me the three types
inadequate immune response
excessive immune response
misdirected immune response
who has more neutrophils
who has less
new borns have a higher granulocyte count
african americans have a lower granulocyte count
kostmann syndrome
inhibits neutrophil maturation
name drugs associated with neutropenia
chloramphenicol, antithyroid meds, analgesia, TCA’s
any drug can produce severe life threatening neutropenia
alcoholics have decreased neutropenia
ethanol toxic effects on marrow precursor cell compromise.
two most common causes of antineutrophil antibodies
SLE & RA
leukocyte adhesion deficiency
higher risk of recurrent bacterial infections
chediak-higashi syndrome
albinism, frequent bacterial infections, mild bleeding diathesis, progressive neuropathy, cranial nerve defects- WBC destroyed before leaving the bone marrow
neutrophil-specific granule deficiency syndrome
impaired chemotaxis and bactericidal activity
frequent bacterial and fungi infections
G-CSF
granulocyte stimulating factor
beneficial for HIV patients- beneficial for neutropenic patients under going elective surgery
what activates the complement system
patogen dependent (classical)
pathogen -independent (alternative)
how does the complement system work
it coats the bacterial in protein to facilitate phagocytosis.
what is the primary organ for complement synthesis
liver
deficiency of C1 esterase inhibitor is responsible for
hereditary angioedema
patients receiving prednisone, stress, exposure to certain drugs and smoking have what?
granylocytosis
what is not useful in the treatment of acute angioedema
androgens catecholamines antihistamines and antkbibrinolytsi are not useful
iga deficiency
recurrent sinus and pulmonary infections
will experience anaphylaxis if exposed to iga
cold autoimmune diseases
igm and iga antibodies agglutinate in response to temp less than 33
macroglossia featured during amyloidosis
large tongue- cardiac dysfunction
DIGEORGE syndrome
diminished or absent thymus gland
latex response vs drug response
30 mintes
drugs 5-10min
does cross senesitivity exist between muscle relaxants
yes
abs cross sensitivity
very low
most common drugs for allergy
muscle relaxants
antibiotics- b lactam drugs, sulfonamides, vancomycin, quinolone
latex
