Infection/sepsis/SSI/Hand hygiene

Question 1

Why is Hand hygiene so important!

Answer 1

• Need 60-80%ETOH - Needs atleast this to be effective!

Question 2

What areas of the hands are most likely to be missed?

(sides of the fingers and webs) +under nail)

Answer 2

What are the 5 moments of hand hygiene?

The 5 Moments.

Moment 1 - before touching a patient.

Moment 2 - before a procedure.

Moment 3 - after a procedure or body fluid exposure risk.

Moment 4 - after touching a patient.

Moment 5 - after touching a patient’s surroundings.

Question 3

5 moments for hand hygiene

What is our role as doctors?

Answer 3

Question 4

What is a SSI?

Definition?

When does it occur? (with what)

Where does it occur?

Answer 4

Question 5

SSI continued

Superficial vs deep incisional”

Answer 5

Question 6

What is the significance of SSI?

Answer 6

1. progession on to more severe infections - patients can become quite unwell
2. Poor wound healing, increasing, cost, time in hospital, burden of disease
3. Difficult infections to treat e.g prosthesis (knee)
4. Has very significant impact on patients recover and the function of the knee!

Question 7

Breast augmentation:

Severe stress, psychological effects, needing further treatments (thus delays in treatment bad for patient)

Question 8

Wound classification:

Clean

Clean contaminated- E.g elective bowel surgeries, appendectecomy (bowel prep)

Contaminated: Inadvert entry into mucosal surface e.g inadvertant cut of adhesions (e.g

Dirty:

Answer 8

Question 9

Prevention: OF SSI

1. Patient factors - Diabetes, immunosuppresant, smoker, Hair removal for prep infection (clippering)

Having surgery that lasts more than 2 hours, Having other medical problems or diseases, Being an elderly adult, Being overweight, Smoking, Having cancer, Having a weak immune system, Having diabetes, Having emergency surgery, Having abdominal surgery

2. Team factors - OT team, Theatre setting
3. Procedural factors - Implants (e.g how they are inserted) Who is handling the insert, e.g changing gloves - when inserting prosthesis. (Some may need to be lathered in antibiotics)
4. Environmental factors: Reduce traffic into the procedure,

Answer 9

Question 10

Antibiotic prophylaxis in surgery

Question 11

SIRS and sepsis

Systemic inflammatory

Answer 11

Question 12

Sepsis - Sirs in the presence of a confirmed or suspected infection

What is Q-SOFA? Tool to determine sepsis

Answer 12

Question 13

What are some examples of SIRS responses:

Causes?

Complications?

Answer 13

Question 14

Management of SIRS

Question 15

Abscess!

Answer 15

What will we find with Abscess:

Question 16

Abscess vs cellulitis!

Answer 16

Question 17

Necrotizing soft tissue infections:

Answer 17

Necrotizing vs Abscess

Necrotizing

DDX:

Question 18

Treatment of necrotizing fascitis:

1) resustication - fluid
2) Broad spectrum abx
3) Debridement to achieve well vascularised tissue - necrotizing
4) reconstruction of soft tissues