Hospital Infections Flashcards
What type of infections are most common in post-op patients?
Respiratory
UTIs
Bacteraemias (cannula associated, MRSA)
Abx related diarrhoea
How are most surgical site infections caused?
Contamination of incision w/pt own microorganisms during surgery
How can surgical infections be minimised pre-op?
- Hair removal: Use electric clippers NOT razors (↑ risk)
- Prophylactic antibiotics
- Remove all jewellery
How can surgical infections be minimised intra-op?
- Prep the site of incision immediately before op using antiseptic (Chlorhexidine/ Povidone‑iodine)
- Cover w/appropriate dressing when done
- use iodophor-impregnated drape
How can surgical infections be minimised post-op?
- Refer to tissue viability nurse for wounds healing by 2° intention
- Antibiotic Tx post-op for dirty/infected surgery
- Use sterile saline for wound cleaning <48 hours post-op
- > 48hours can use tap water for cleaning
When can patients shower post-op?
> 48hours
What is post-op fever?
Temp >38°C on 2 consecutive days post-op
OR
Temp >39°C on any 1 post-op day
What are the causes of Post-op fever at 0-48hours?
- Pyretic response to surgery- MOST COMMON
- TSS from Staph Aureus/group A beta-haemolytic Strep infection
- Drug induced: Heparin, Allopurnol, Ig, Salicylates, PhenyT, Furosemide, Thiazdies, Abx
- Malignant hyperthermia
- Transfusion reactions
- Traumatic surgery
- Transplant rejection
How is post-op fever treated?
Conservative: Self-limiting, resolves in 2-4days
Antipyrexial: Paracetamol
Tx underlying cause
What are the causes of Post-op fever at >48hours-7days?
90% infectious cause
-Infection from surgery: Wound cellulitis
-Infection from invasive access: UTI, Pneumonia, Cannula-related thrombophlebitis, catheter related infections
-Infection from blood products: RARE, Yersinia, Pseudomonas, Staph, Salmonella , enterococci, Clostridium
CONSIDER: OH- withdrawal
What infectious cause is likely to cause pyrexia post-op in the first 1-3days?
Group A Strep
Clostridium
When are fat emboli post-op most likely to present?
48-72hours
What are the causes of Post-op fever at >7-28days?
INFECTION:
- UTI
- Pneumonia
- C.Diff
- Wound cellulitis
- Foreign-body reaction
- OSTEOMYELITIS (complication of orthopaedic surgery seen 2w post-op)
- DVT/PE
What are the causes of Post-op fever at 4weeks?
- Osteomyelitis (implant infection)
- Infective endocarditis
What are the signs of malignant hyperthermia? How is it treated?
Tachycardia Metabolic acidosis ↑↑temperature Muscle rigidity Tx = Dantrolene