Infection and Sepsis Flashcards
Classifications of surgical wounds and risks of SSI
Clean, <5%
Clean contaminated, 5-10%
Contaminated 15-25%
Dirty 25-40%
Definition of clean surgical wound procedure. Give example
-no inflammation encountered during procedure
-no break in sterile technique
-respiratory/ailmentary/ genitourinary system no entered
Ex. inguinal hernia repair
Definition of clean contaminated surgical wound. Give example.
- incision which respiratory/ alimentary / genitourinary tract entered
- BUT no contamination encountered
ex. cholecystectomy
Definition of contaminated surgical wound. Give example.
-Major break in sterile technique OR
-Gross spillage in GI tract OR
-Incision in acute, non-purulent inflammation encountered OR
-open traumatic wounds more than 12-24 hours old
Ex. appendiectomy
Definition of dirty surgical wound. Give example.
-perforated viscera OR
-acute inflammation with pus OR
Traumatic wounds with delayed treatment: gross contamination or revitalised tissue
Preoperative prevention of SSI
Showering (night prior to OT)
Hair removal
Patient and staff appropriate non-sterile wear
Antibiotic prophylaxis (within 1 hour of incision)
Intraoperative prevention of SSI
Hand decontamination
Incision drapes/ Sterile gown/ Gloves
Antiseptic skin preparation immediately before skin incision
Antibiotics (repeat dose if OT longer than half life of antibiotic, usu >4 hours or blood loss > 1500ml)
Wound dressing
SSC: Hour 1 bundle
1) Measure lactate
2) Obtain blood culture before administering antibiotics
3) Broad spectrum antibiotics
4) Rapid administration of 30ml/kg crystalloid of for hypotension or lactate > 40mmol/L
5) Vasopressors if hypotensive (target MAP > 65mmHg)
* remeasure lactate if initial lactate > 2 mmol
SSC: Definition of sepsis
Life-threatening organ dysfunction caused by dysregulated host response to infection
SSC: Definition of septic shock
Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with high risk of mortality
Definition of SIRS
Dysregulated inflammatory response to a non-infectious insult
ex. surgery/ trauma/ pancreatitis/ ischemia/ burns
Definition of sepsis
SIRS +
Presence of suspected/proven infection
Criteria for SIRS
Any two of the following criteria: Temp < 36 or > 38.3C HR >90 bpm RR >20 or pCO3 < 4.3 kPa WCC <4 or >12 or >10% immature neutrophils
Definition of severe sepsis
Sepsis with evidence of organ dysfunction or tissue hypoperfusion
Signs of severe sepsis
Peripheral vasoconstriction
Oliguria
Metabolic acidosis
Change in mental state
Definition of septic shock
Sepsis induced hypotension which persists despite adequate fluid resuscitation
Definition of MODS (multi-organ dysfunction syndrome)
Failure of 2 or more organs which are unable to maintain homeostasis without intervention
Pathogenesis of SIRS
Initiation of inflammatory cascade:
-if infection, by endotoxin/exotoxin
-if non-infection. by local pro-inflammatory cytokines (IL 1,6,8, TNF-alpha)
overwhelming response to inflammatory cascade with dysregulation, excessive cytokines enter systemic circulation leading to SIRS
Components of guidelines for Surviving Sepsis Campaign 2016-2018
- Hour 1 bundle
- Initial resuscitation
- Diagnosis
- Antibiotics Therapy
- Source Control
- Fluid therapy
- Vasopressors
- Blood Products
- Mechanical Ventilation for sepsis induced ALI/ARDS
- Glucose Control
- DVT prophylaxis
- Stress Ulcer Prophylaxis
Hour 1 sepsis bundle
1) Measure lactate
2) Obtain blood cultures
3) Administer broad spectrum antibiotics
4) rapid administration of 30 ml/kg crystalloid for hypotension or lactate >4 mmol
5) Apply vasopressors to maintain MAP >65mmHg
