Perioperative Infection Control Flashcards
what is a surgical site infection a type of?
hospital acquired infection
what is classed as a hospital acquired infection?
any infection which occurs from when a patient goes into hospital up to 30 days post discharge
what is one of the most common nosocomial infections?
SSI
what are the 3 broad factors that can contribute to SSI?
patient
surgery
environment
what can the development of SSI lead to?
poor healing
delayed healing time
increased medical costs
possible revision surgery
detrimental effect on client relationships
reduced patient welfare
increased antibiotic use
what is important when discussing surgery with owners?
highlight risk of SSI in any surgery
what is the main issue with increased antibiotic use?
risk of resistant infection
antibiotic stewardship
what are the steps to take when a SSI is suspected?
identify infection location
assess the extent of the infection
culture for targeted antibiotics
good wound management
good infection control techniques
what should be assessed about the extent of an SSI?
size
is it just around the wound
is it deeper and involved with implants
what is involved in good wound management?
aseptic handling
keep clean
apply dressings as needed
what is required for SSI to form?
introduction of microorganisms into the surgical wound
what are the sources of SSI?
exogenous
endogenous
where do exogenous sources of SSI originate from?
source outside of the patient (e.g. surgeon, equipment or environment)
where do endogenous sources of SSI originate from?
the patient themselves (e.g. patient flora)
what source do most SSIs originate from?
endogenous
what areas of preop management require compliance in order to reduce SSI?
antimicrobial prophylaxis
pre-op bathing
hair removal
aseptic prep
care of prepped surgical site
hand hygiene
what is the most crucial factor in preventing SSI?
hand hygiene
what can be done to prevent endogenous sources of SSI?
thorough clipping
no clipper rash
large margins
removal of hair from trolley
correct skin prep with right solution and contact time
what are the factors which predispose SSI?
patient
environment
treatment
what can be done to prevent exogenous sources of SSI?
good surgeon compliance with prep
equipment sterilisation
environment well cleaned and managed
what are the main patient factors which may influence SSI?
body condition or age
immunosuppression
endocrinopathies
remote infection
skin disease
recent operation
prior site radiation
perioperative temperature
how may body condition affect risk of SSI?
malnutrition could lead to lowered albumin and so poorer immune response
how may age affect risk of SSI?
less able to fight infection
over 10 - poor immune response
under 1 year - underdeveloped immune system
how may immunosuppression or endocrinopathies affect risk of SSI?
reduced ability to fight infection
may be on medical therapy like steroids which affects immunity
how may remote infection affect risk of SSI?
seeding of infection
bacteria already in blood stream
how can you be aware of remote infection before surgery?
may not always be aware
look for other wounds / areas of infection
how may skin disease affect risk of SSI?
bacteria from skin surface can enter wound
how may skin disease affect surgery?
elective procedures may be postponed until skin has healed
how may recent operation affect risk of SSI?
suture material is FB
tissue adhesions
how may perioperative temperature affect risk of SSI?
vasoconstriction is hypothermic may affect blood flow to wound and limit WBC
what are the main environment factors which may influence SSI?
patient prep
cross contamination
aseptic technique
theatre conduct
cleaning methods
inadequate ventilation
how can patient prep be performed to reduce SSI risk?
separate area for prep
correct products used for prep with correct contact time
avoid pre clipping
clip well and throughly (no rash or left hair)
how can cross contamination be prevented to reduce SSI risk?
good handwashing
what aspects of theatre conduct can reduce SSI risk?
minimal personnel
correct attire worn at all times
how can theatre cleaning be performed to reduce SSI risk?
correct / most appropriate disinfectants used
damp dusting performed
regular deep cleaning
deep cleaning following dirty surgeries/infectious cases
dirty surgeries at end of day
how can ventilation reduce SSI risk?
higher temperatures provide better environment for bacteria to grow
slightly cooler and good air flow can prevent
what types of ventilation are available?
ultraclean
linear flow
air conditioning
what are the main treatment factors which may influence SSI?
surgical time
experience
inadequate antibiotic prophylaxis
drains
emergency procedure
surgical implants
suture material selection
how does surgical time affect risk of SSI?
infection rate thought to double with every hour of surgical time
how does experience affect risk of SSI?
halsteads principles
inexperienced surgeons may take longer
what are Halsteads principles?
handle tissues gently
control haemorrhage carefully
preserve blood supply
strict asepsis
minimise tissue tension
appose tissues correctly
remove dead space
why are drains an SSI risk?
entry into body for bacteria to track up
how do emergency patients affect risk of SSI?
patient may not be ideal surgical candidate and may have SSI risks but will need surgery to prevent death
how do surgical implants affect risk of SSI?
foreign body
how does suture material selection affect risk of SSI?
correct choice for tissue being sutured
what is the most important aspect of infection control?
hand hygiene
what are the 5 moments for hand hygiene?
before and after touching a patient
before and after touching patient environment
before aseptic procedure
skin contamination with body fluids
before gloving
what handwashing technique should be followed?
WHO handwash
describe WHO handwash
palm to palm
right palm over left dorsum with fingers interlocked and vice versa
palm to palm with fingers interlocked
backs of fingers to opposing palms with fingers interlocked
rotational rubbing of left thumb in right palm and vice versa
rotational rubbing of finger tips in opposing palm and vice versa
how does surgical classification influence SSI?
relationship between classification and SSI (more dirty = more SSI)
what are the surgical classification categories of wounds/procedures?
clean
clean-contaminated
contaminated
dirty
what are clean wounds / procedures?
non-traumatic surgical wounds that do not involve the opening of the respiratory, GI, genitourinary or oropharyngeal tracts
what are examples of clean surgical wounds/procedures?
TPLO
total hip
what are clean - contaminated wounds / procedures?
surgical wounds with aseptic prep that involve entering the respiratory, GI, genitourinary or oropharyngeal tracts in controlled conditions or placing a drain
what are contaminated wounds / procedures?
open wounds
spillage of GI contents/infected urine
break in aseptic technique
what are dirty wounds / procedures?
old purulent wounds, foreign bodies, faecal
contamination
what are examples of dirty wounds?
RTA
dog bite
stick injury
what are examples of contaminated wounds/procedures?
leakage of GI contents into abdomen
what is the published infection rate for clean surgeries?
0.4-4%
what are the clean wounds most likely to result in infection?
duration over 90 mins
implant use
inexperienced surgeon
what is the published infection rate for clean - contaminated surgeries?
4.5-9.3%
what is indicated for clean - contaminated surgeries?
antimicrobial prophylaxis
culture / targeted use
what is the published infection rate for contaminated surgeries?
5.8-28.6%
what can help reduce degree of infection in contaminated wounds?
good management
what is involved in management of contaminated wounds?
lavage
debridement
antibiotic therapy with swab for culture
when should antibiotics be used?
Implants where infection would be catastrophic
Surgery over 90 minutes
Clean/ contaminated, contaminated, dirty procedures
what is involved in the selection of antibiotics for surgical use?
VS decision
Most likely bacterial contaminant (Staphylococcus, e.coli)
Culture results
what is the most effective time for prophylactic antibiotic administration?
30mins - 1 hour prior to surgery (IV)
how frequently should prophylactic antibiotic administration occur during surgery?
every 90 mins
when should prophylactic antibiotic administration stop following surgery?
within 24 hours of clean surgery
how long should sterile dressings be on a wound post op?
24-48 hours
should dressings be reapplied if soiled?
if within 24-48 hours post op then yes but no evidence to support continued dressing use after this time
what is the risk with repeated dressing changes?
contamination and infection
what is involved in post operative care to prevent infection?
apply sterile dressing for initial 24-
48 hour period
Remove drains as soon as possible
Strict hygiene
Nutrition and monitor
what is drain removal based on?
reduced production
VS decision
what is involved in strict post op hygiene?
kennel cleaning
handwashing
why is nutrition in the post op period crucial?
bosst immune system
management of nausea crucial
what are patients to be monitored for in the post op period?
pain
temperature
obs
wound itself for signs of infection
how may patients with implants be managed?
aseptic handling of wound
restriction of exercise
what should the wound be observed for?
exudate increase or change
heat
swelling
pain
what should the owner be made aware of on patient discharge?
signs of wound infection
