Peri operative infection

Question 1

What is a surgical site infection?

Answer 1

A type of hospital aquired infection

Question 2

What are the 3 categories of SSI?

Answer 2

Superficial incisional ( skin and subcutaneous tissue)
Deep insisional (Fascial/muscle layer)
Organ/space infection ( anything other than above)

Question 3

What is the perioperative period?

Answer 3

pre-med to recovery

Question 4

What are the disadvantages of a SSI?

Answer 4

Delayed healing 
Poor cosmesis
Increased medical costs 
possible revision surgery 
client relationships 
patient welfare 
increased anti biotic use

Question 5

What is the most common cultured bacteria from SSI?

Answer 5

Staphlococci

Question 6

What is a Biofilm?

Answer 6

Bacteria which attach to a surface in large numbers or communities enabling them to adapt to their environment.

Question 7

What are the characteristics of a biofilm?

Answer 7

Resistant
Quiescent state ( negative on culture)
Suspect if patient infected or re-infection occurs after treatment

Question 8

How is an infected patient treated?

Answer 8

Barrier nursed
AB based on culture and sensitivity 
Strict aseptic wound management
Debridement of necrotic tissue 
covering of the wound
Record presence of bacteria when it was isolated, how it was treated, whether treatment was successful

Question 9

What is an Exogenous micro-organism?

Answer 9

A source outside the patient (surgeon, equipment)

Question 10

What is a Endogenous micro-organism?

Answer 10

A source of infection from within the patient

patient skin flora

Question 11

What are the 3 categories of factors that may predispose a patient to infection?

Answer 11

Patient
Environment
Treatment

Question 12

Why is compliance important to prevent infection?

Answer 12

Scrub protocols
antimicrobial propylaxis
Hand hygiene
aseptic

Question 13

List the patient factors the pre-dispose them to infection?

Answer 13

Body condition (malnutrition decreased albumin levels)
Age ( over 10 poor immune system below 1 under developed immune system)
Immunosupressed (diabetes mellitus, steriods, endocrinopathies)
Bacteria already within the blood
Skin disease
Recent operation (suture material)
Prior site radiation
Perioperative temperature (Vasoconstriction, shivering increases o2 consumption)

Question 14

What are the environmental factors that pre-dispose a patient to infection?

Answer 14

Patient preparation 
Cross contamination (Handwashing)
Aseptic technique 
Theatre conduct(personnel, attire) 
Cleaning methods (damp dusting lamps, disinfectant)
Inadequate ventilation

Question 15

What are the treatment factors that pre-dispose a patient to infection?

Answer 15

Surgical time (infection rate doubles with every hour) 
Experience (halsteads principles) 
Inadequate antibiotic
Drains 
Emergency procedure 
surgical implants
suture material

Question 16

When should you wash your hands?

Answer 16

Before and after touching a patient 
Before and after touching surroundings 
Before carrying out aseptic tasks 
before and after gloving 
after exposure to contaminated tissue/fluids

Question 17

What steps should be followed when hand washing?

Answer 17

WHO 6 steps

Question 18

What are the Halstead principles?

Answer 18

Gentle handling of tissue 
adequate haemostasis
preservation of blood supply
strict aseptic technique
minimum tension at wound closure 
good tissue approximation 
obliteration of dead space

Question 19

What are the four classifications of surgery?

Answer 19

Clean (Non traumatic surgical wounds, spay, ortho, wounds that do not involve GI genitourinary or oropharynegeal)
Clean-contaminated (entering GI, genitourinary, or oropharyngeal tracts controlled condition)
Contaminated (spillage of contents entering the above tracts)
Dirty (old purulent wound, foreign body, faecal material)

Question 20

What will help minimise infection during surgery?

Answer 20

Lavage
debridement
Antibiotics
wound swab

Question 21

What are the infection rates for clean
clean contaminated
contaminated and
dirty wounds?

Answer 21

Clean 0.4-4%
Clean contaminated 4.5-9.3%
Contaminated 5.8-28.6%

Question 22

When should an antibiotic be used?

Answer 22

Surgical implants
surgery over 90 minutes
clean contaminated, contaminated, dirty procedures

Question 23

How is the selection of AB made?

Answer 23

Most likely bacterial contaminant, staphyloccocus of ecoli

Culture results

Question 24

When should antibiotics be administered?

Answer 24

So they are effective at the time of surgery 30-1 hour prior to surgery
Discontinued withing 24 hours of completion of clean surgeries

Question 25

How should you care for a surgical wound after surgery?

Answer 25

Apply sterile dressing 24-48 hours after surgery
Patient interferance
remove drains asap
(cover stomat of active drains, cover exit site of penrose drain)
strict hygiene
nutrition (protein needed for good wound healing)
monitor

Question 26

How should you carry out a clinical audit?

Answer 26

Record any infections or complications during surgery
identify problem area
review
implement changes (ensure evidence based)
audit and review changes regularly