Peri operative infection Flashcards
What is a surgical site infection?
A type of hospital aquired infection
What are the 3 categories of SSI?
Superficial incisional ( skin and subcutaneous tissue) Deep insisional (Fascial/muscle layer) Organ/space infection ( anything other than above)
What is the perioperative period?
pre-med to recovery
What are the disadvantages of a SSI?
Delayed healing Poor cosmesis Increased medical costs possible revision surgery client relationships patient welfare increased anti biotic use
What is the most common cultured bacteria from SSI?
Staphlococci
What is a Biofilm?
Bacteria which attach to a surface in large numbers or communities enabling them to adapt to their environment.
What are the characteristics of a biofilm?
Resistant
Quiescent state ( negative on culture)
Suspect if patient infected or re-infection occurs after treatment
How is an infected patient treated?
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
What is an Exogenous micro-organism?
A source outside the patient (surgeon, equipment)
What is a Endogenous micro-organism?
A source of infection from within the patient
patient skin flora
What are the 3 categories of factors that may predispose a patient to infection?
Patient
Environment
Treatment
Why is compliance important to prevent infection?
Scrub protocols
antimicrobial propylaxis
Hand hygiene
aseptic
List the patient factors the pre-dispose them to infection?
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)
What are the environmental factors that pre-dispose a patient to infection?
Patient preparation Cross contamination (Handwashing) Aseptic technique Theatre conduct(personnel, attire) Cleaning methods (damp dusting lamps, disinfectant) Inadequate ventilation
What are the treatment factors that pre-dispose a patient to infection?
Surgical time (infection rate doubles with every hour) Experience (halsteads principles) Inadequate antibiotic Drains Emergency procedure surgical implants suture material
When should you wash your hands?
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
What steps should be followed when hand washing?
WHO 6 steps
What are the Halstead principles?
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
What are the four classifications of surgery?
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)
What will help minimise infection during surgery?
Lavage
debridement
Antibiotics
wound swab
What are the infection rates for clean
clean contaminated
contaminated and
dirty wounds?
Clean 0.4-4%
Clean contaminated 4.5-9.3%
Contaminated 5.8-28.6%
When should an antibiotic be used?
Surgical implants
surgery over 90 minutes
clean contaminated, contaminated, dirty procedures
How is the selection of AB made?
Most likely bacterial contaminant, staphyloccocus of ecoli
Culture results
When should antibiotics be administered?
So they are effective at the time of surgery 30-1 hour prior to surgery
Discontinued withing 24 hours of completion of clean surgeries
How should you care for a surgical wound after surgery?
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
How should you carry out a clinical audit?
Record any infections or complications during surgery
identify problem area
review
implement changes (ensure evidence based)
audit and review changes regularly
