Lecture 1: Immunity and Infection CO Flashcards
SURGICAL SITE INFECTIONS
- 14-16% of ?
- 14-16% of nosocomial infections
SURGICAL SITE INFECTIONS
- Highest rates in ?
- Highest rates in intra-abdominal cases
SURGICAL SITE INFECTIONS
- Patient, microbial, & wound related factors: review table 26.1 (slide 3)***
- Patient, microbial, & wound related factors: review table 26.1 (slide 3)***
SURGICAL SITE INFECTIONS
- _______, including _____, is predominant cause
- S. aureus, including MRSA, is predominant cause
SURGICAL SITE INFECTIONS
- Presentation usually w/i __ days of surgery (Local inflammation, poor wound healing, sx of systemic infection)
- Presentation usually w/i 30 days of surgery (Local inflammation, poor wound healing, sx of systemic infection)
SURGICAL SITE INFECTIONS
- Gold standard dx ?
- Gold standard dx: aseptically obtained wound culture
SURGICAL SITE INFECTIONS
- Widespread use of broad-spectrum abx are contributing to ?
- Widespread use of broad-spectrum abx are contributing to resistant infections
SSI PREVENTION #1
Frequent handwashing
SSI PREVENTION
Appropriate administration of prophylactic antibiotics (abx):
- Usually within _ hour prior to incision (within _ hours for vancomycin and fluoroquinolones)
- Redose in prolonged surgery (>_ hours)
- Usually within 1 hour prior to incision (within 2 hours for vancomycin and fluoroquinolones)
- Redose in prolonged surgery (>4 hours)
SSI PREVENTION
Appropriate administration of prophylactic antibiotics (abx):
- Most common abx is a first-generation ?
- Most common abx is a first-generation cephalosporin (broad spectrum, low side effects, high tolerability)
SSI PREVENTION
Appropriate administration of prophylactic antibiotics (abx):
- Small bowel also needs ___________ coverage; large bowel and female genital tract surgery need ___________ coverage
- Small bowel also needs gram-negative coverage; large bowel and female genital tract surgery need anaerobic coverage
SSI PREVENTION
Smoking increases respiratory & wound infections
- Preferred to abstain for ?
ETOH: Significant consumption leads to ?
- ? abstinence recommended
Attempt to optimize diabetics preoperatively
- *check ?
Encourage ____________________ in cachexia or obesity before major surgery
If possible, postpone surgery with ?
Non-specific sx’s (fever, malaise, elevated WBC): attempt to ?
4-8 weeks
immunocompromise, one month
A1C
nutritional optimization
active infection at intended surgical site
ID source of infection prior to surgery
SSI PREVENTION
____________ increases likelihood of SSI***
Provide active warming: __________ increases SSI***
Adequate __________ decreases SSI by improving subcutaneous oxygen tension
__________ should be avoided due to vasoconstriction
Optimize glucose control: hyperglycemia inhibits ___________ function***
Tissue hypoxia
- Optimize oxygenation with titration of inspired O2
hypothermia
analgesia
Hypocapnia
leukocyte
BLOODBORNE INFECTIONS
***
Central line infection: the best “treatment” is _________
CDC “Top 5 recommendations” =
Routine practice of using hand sanitizer & scrubbing ports with alcohol before every use of CVL!!!
prevention
(1) handwashing prior to insertion or maintenance (soap & water or hand sanitizer)
(2) using full-barrier precautions (hat, mask, sterile gown, sterile area covering) during insertion
(3) cleaning the skin with chlorhexidine
(4) avoiding the femoral site & peripheral arms when possible - IJ & Subclavian with lower risk; consider pneumothorax risk in Subclav
(5) routine daily inspection of catheters w/ removal ASAP
TRANSFUSION
_________ contamination is the greatest risk of transfusion-transmitted disease (NOT complication)
1: 5,000 for ________ (stored at room temp) &
1: 50,000 for ________
Bacterial
platelets
PRBCs
TRANSFUSION
Viral contamination very high or low due to ?
Risk of HIV-1 and hepatitis C virus transmission: 1 in __________ blood transfusions
low, vigorous screening (minipool nucleic acid amplification)
2 million
TRANSFUSION
Dual risk of?
Risk conferred even in autologous transfusion r/t ?
Leukodepletion increases or decreases risk?
Platelets: X of every 1000 to 3000 units of PLT have bacterial contamination
? is a major factor in microbial growth
bacterial contamination of product & immunosuppression
NK cell inhibition
decreases risk
one
Room temp storage
SEPSIS: Septic shock
defined by ?
Sepsis: SIRS w/ ?
*Surgery and anesthesia should be postponed to at least initiate treatment
defined by hypotension not reversed with IVF’s
Sepsis: SIRS w/ infectious source..... Bacteremia Fungemia Parasitemia Viremia Other
SEPSIS: SIRS
- SIRS response can lead to ?
- Surgery & anesthesia should be postponed to at least initiate treatment
systemic vasodilation, altered capillary permeability, & MSOF
Pancreatitis
Burns
Trauma
Other
SEPSIS: Classic distributive shock
defined by?
*Surgery & anesthesia should be postponed to at least initiate treatment
high output cardiac failure with hypotension, bounding pulses, & wide pulse pressure
Source control surgery:
4-Ds of Source Control:
Underlying cause of infection requires urgent surgery (REMOVE SOURCE)
Ex: abscesses, infective endocarditis, bowel perforation or infarction, infected prosthetic device, endometritis, and necrotizing fasciitis
4-Ds of Source Control: Drainage Debridement Device Removal Definitive Control (bowl resection, cholecystectomy)
SEPSIS: Dx
Dx:
via culture; important to culture all likely sources (blood, urine, sputum minimum)
narrow abx coverage ASAP
SEPSIS: Tx
Tx:
Time sensitive
empiric antibiotics then tailored to cultured organism ASAP
goal directed therapy with end organ perfusion as a goal - MAP >65, CVP 8-12, adequate UOP, correction of metabolic acidosis, mixed venous O2 sat >70%
SEPSIS: Anesthetic
Note limited reserve; prone to ? Will need?
Adequate vascular access for ?
Prioritize ?
Anticipate ?
hypoxemia & hypotension; invasive monitoring (ABP)
resuscitation
antibiotic administration
ICU admission