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Advanced Clinical Nursing Theory > Perioperative Infection Control > Flashcards

Perioperative Infection Control Flashcards

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1
Q

what is a surgical site infection a type of?

A

hospital acquired infection

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2
Q

what is classed as a hospital acquired infection?

A

any infection which occurs from when a patient goes into hospital up to 30 days post discharge

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3
Q

what is one of the most common nosocomial infections?

A

SSI

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4
Q

what are the 3 broad factors that can contribute to SSI?

A

patient
surgery
environment

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5
Q

what can the development of SSI lead to?

A

poor healing
delayed healing time
increased medical costs
possible revision surgery
detrimental effect on client relationships
reduced patient welfare
increased antibiotic use

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6
Q

what is important when discussing surgery with owners?

A

highlight risk of SSI in any surgery

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7
Q

what is the main issue with increased antibiotic use?

A

risk of resistant infection
antibiotic stewardship

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8
Q

what are the steps to take when a SSI is suspected?

A

identify infection location
assess the extent of the infection
culture for targeted antibiotics
good wound management
good infection control techniques

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9
Q

what should be assessed about the extent of an SSI?

A

size
is it just around the wound
is it deeper and involved with implants

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10
Q

what is involved in good wound management?

A

aseptic handling
keep clean
apply dressings as needed

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11
Q

what is required for SSI to form?

A

introduction of microorganisms into the surgical wound

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12
Q

what are the sources of SSI?

A

exogenous
endogenous

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13
Q

where do exogenous sources of SSI originate from?

A

source outside of the patient (e.g. surgeon, equipment or environment)

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14
Q

where do endogenous sources of SSI originate from?

A

the patient themselves (e.g. patient flora)

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15
Q

what source do most SSIs originate from?

A

endogenous

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16
Q

what areas of preop management require compliance in order to reduce SSI?

A

antimicrobial prophylaxis
pre-op bathing
hair removal
aseptic prep
care of prepped surgical site
hand hygiene

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17
Q

what is the most crucial factor in preventing SSI?

A

hand hygiene

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18
Q

what can be done to prevent endogenous sources of SSI?

A

thorough clipping
no clipper rash
large margins
removal of hair from trolley
correct skin prep with right solution and contact time

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19
Q

what are the factors which predispose SSI?

A

patient
environment
treatment

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20
Q

what can be done to prevent exogenous sources of SSI?

A

good surgeon compliance with prep
equipment sterilisation
environment well cleaned and managed

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21
Q

what are the main patient factors which may influence SSI?

A

body condition or age
immunosuppression
endocrinopathies
remote infection
skin disease
recent operation
prior site radiation
perioperative temperature

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22
Q

how may body condition affect risk of SSI?

A

malnutrition could lead to lowered albumin and so poorer immune response

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23
Q

how may age affect risk of SSI?

A

less able to fight infection
over 10 - poor immune response
under 1 year - underdeveloped immune system

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24
Q

how may immunosuppression or endocrinopathies affect risk of SSI?

A

reduced ability to fight infection
may be on medical therapy like steroids which affects immunity

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25
Q

how may remote infection affect risk of SSI?

A

seeding of infection
bacteria already in blood stream

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26
Q

how can you be aware of remote infection before surgery?

A

may not always be aware
look for other wounds / areas of infection

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27
Q

how may skin disease affect risk of SSI?

A

bacteria from skin surface can enter wound

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28
Q

how may skin disease affect surgery?

A

elective procedures may be postponed until skin has healed

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29
Q

how may recent operation affect risk of SSI?

A

suture material is FB
tissue adhesions

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30
Q

how may perioperative temperature affect risk of SSI?

A

vasoconstriction is hypothermic may affect blood flow to wound and limit WBC

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31
Q

what are the main environment factors which may influence SSI?

A

patient prep
cross contamination
aseptic technique
theatre conduct
cleaning methods
inadequate ventilation

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32
Q

how can patient prep be performed to reduce SSI risk?

A

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)

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33
Q

how can cross contamination be prevented to reduce SSI risk?

A

good handwashing

34
Q

what aspects of theatre conduct can reduce SSI risk?

A

minimal personnel
correct attire worn at all times

35
Q

how can theatre cleaning be performed to reduce SSI risk?

A

correct / most appropriate disinfectants used
damp dusting performed
regular deep cleaning
deep cleaning following dirty surgeries/infectious cases
dirty surgeries at end of day

36
Q

how can ventilation reduce SSI risk?

A

higher temperatures provide better environment for bacteria to grow
slightly cooler and good air flow can prevent

37
Q

what types of ventilation are available?

A

ultraclean
linear flow
air conditioning

38
Q

what are the main treatment factors which may influence SSI?

A

surgical time
experience
inadequate antibiotic prophylaxis
drains
emergency procedure
surgical implants
suture material selection

39
Q

how does surgical time affect risk of SSI?

A

infection rate thought to double with every hour of surgical time

40
Q

how does experience affect risk of SSI?

A

halsteads principles
inexperienced surgeons may take longer

41
Q

what are Halsteads principles?

A

handle tissues gently
control haemorrhage carefully
preserve blood supply
strict asepsis
minimise tissue tension
appose tissues correctly
remove dead space

42
Q

why are drains an SSI risk?

A

entry into body for bacteria to track up

43
Q

how do emergency patients affect risk of SSI?

A

patient may not be ideal surgical candidate and may have SSI risks but will need surgery to prevent death

44
Q

how do surgical implants affect risk of SSI?

A

foreign body

45
Q

how does suture material selection affect risk of SSI?

A

correct choice for tissue being sutured

46
Q

what is the most important aspect of infection control?

A

hand hygiene

47
Q

what are the 5 moments for hand hygiene?

A

before and after touching a patient
before and after touching patient environment
before aseptic procedure
skin contamination with body fluids
before gloving

48
Q

what handwashing technique should be followed?

A

WHO handwash

49
Q

describe WHO handwash

A

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

50
Q

how does surgical classification influence SSI?

A

relationship between classification and SSI (more dirty = more SSI)

51
Q

what are the surgical classification categories of wounds/procedures?

A

clean
clean-contaminated
contaminated
dirty

52
Q

what are clean wounds / procedures?

A

non-traumatic surgical wounds that do not involve the opening of the respiratory, GI, genitourinary or oropharyngeal tracts

53
Q

what are examples of clean surgical wounds/procedures?

A

TPLO
total hip

54
Q

what are clean - contaminated wounds / procedures?

A

surgical wounds with aseptic prep that involve entering the respiratory, GI, genitourinary or oropharyngeal tracts in controlled conditions or placing a drain

55
Q

what are contaminated wounds / procedures?

A

open wounds
spillage of GI contents/infected urine
break in aseptic technique

56
Q

what are dirty wounds / procedures?

A

old purulent wounds, foreign bodies, faecal
contamination

57
Q

what are examples of dirty wounds?

A

RTA
dog bite
stick injury

58
Q

what are examples of contaminated wounds/procedures?

A

leakage of GI contents into abdomen

59
Q

what is the published infection rate for clean surgeries?

A

0.4-4%

60
Q

what are the clean wounds most likely to result in infection?

A

duration over 90 mins
implant use
inexperienced surgeon

61
Q

what is the published infection rate for clean - contaminated surgeries?

A

4.5-9.3%

62
Q

what is indicated for clean - contaminated surgeries?

A

antimicrobial prophylaxis
culture / targeted use

63
Q

what is the published infection rate for contaminated surgeries?

A

5.8-28.6%

64
Q

what can help reduce degree of infection in contaminated wounds?

A

good management

65
Q

what is involved in management of contaminated wounds?

A

lavage
debridement
antibiotic therapy with swab for culture

66
Q

when should antibiotics be used?

A

Implants where infection would be catastrophic
Surgery over 90 minutes
Clean/ contaminated, contaminated, dirty procedures

67
Q

what is involved in the selection of antibiotics for surgical use?

A

VS decision
Most likely bacterial contaminant (Staphylococcus, e.coli)
Culture results

68
Q

what is the most effective time for prophylactic antibiotic administration?

A

30mins - 1 hour prior to surgery (IV)

69
Q

how frequently should prophylactic antibiotic administration occur during surgery?

A

every 90 mins

70
Q

when should prophylactic antibiotic administration stop following surgery?

A

within 24 hours of clean surgery

71
Q

how long should sterile dressings be on a wound post op?

A

24-48 hours

72
Q

should dressings be reapplied if soiled?

A

if within 24-48 hours post op then yes but no evidence to support continued dressing use after this time

73
Q

what is the risk with repeated dressing changes?

A

contamination and infection

74
Q

what is involved in post operative care to prevent infection?

A

apply sterile dressing for initial 24-
48 hour period
Remove drains as soon as possible
Strict hygiene
Nutrition and monitor

75
Q

what is drain removal based on?

A

reduced production
VS decision

76
Q

what is involved in strict post op hygiene?

A

kennel cleaning
handwashing

77
Q

why is nutrition in the post op period crucial?

A

bosst immune system
management of nausea crucial

78
Q

what are patients to be monitored for in the post op period?

A

pain
temperature
obs
wound itself for signs of infection

79
Q

how may patients with implants be managed?

A

aseptic handling of wound
restriction of exercise

80
Q

what should the wound be observed for?

A

exudate increase or change
heat
swelling
pain

81
Q

what should the owner be made aware of on patient discharge?

A

signs of wound infection

82
Q
A

Advanced Clinical Nursing Theory (36 decks)

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