Perioperative Infection Control

Question 1

what is a surgical site infection?

Answer 1

a type of hospital-acquired infection (HAI)

Question 2

in which timeframe can a HAI occur?

Answer 2

from when patient goes into hospital up to 30 days post-discharge

Question 3

what are the complications of SSIs?

Answer 3

poor healing, delayed healing time

increased medical costs

possible revision surgery

damage to client relationships

poorer patient welfare

increased antibiotic use

Question 4

what are the 5 steps that should be taken if a SSI is suspected?

Answer 4

identify infection

assess extent of infection

begin culture-based antibiosis

good wound management

good infection control techniques

Question 5

what are exogenous factors for infection?

Answer 5

from a source outside the patient e.g. surgeon, equipment, environment

Question 6

what are endogenous factors for infection?

Answer 6

most common is patients own skin flora

Question 7

what are the 3 main types of factors predisposing patients to infection?

Answer 7

patient factors

environmental factors

treatment factors

Question 8

what patient factors can predispose a patient to infection?

Answer 8

body condition/age - poorer in young and old, malnutrition increases risk

immunosuppression/endocrinopathies - steroids, diabetes

remote infection - seeding, bacteria already in bloodstream

skin disease

recent operation - suture material, tissue adhesions

prior site radiation

perioperative temperature - vasoconstriction

Question 9

which environmental factors can predispose a patient to infection?

Answer 9

poor patient prep - consider surround area, products

cross-contamination

theatre conduct - personnel, attire

theatre cleaning methods

inadequate ventilation

Question 10

what treatment factors might predispose a patient to infection?

Answer 10

surgical time - risk increases linearly

surgeon experience

inadequate ab prophylaxis

drain placement

emergency procedures

surgical implants

suture material selection

Question 11

what is the most important aspect of infection control?

Answer 11

hand hygiene

Question 12

when should we be washing our hands?

Answer 12

before and after touching a patient

before and after touching surroundings

before carrying out aseptic tasks

before gloving

after possible exposure to contaminated fluids/tissue

Question 13

what are the 4 surgical wound classifications?

Answer 13

clean
clean-contaminated
contaminated
dirty

Question 14

what is a clean wound?

Answer 14

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

Question 15

what is a clean-contaminated wound?

Answer 15

surgical wounds which involve entering the respiratory, GI, genourinary or oropharyngeal tracts in controlled conditions or placement of a drain

Question 16

what is a contaminated wound?

Answer 16

open wounds

spillage of GI contents/infected urine

break in aseptic technique

Question 17

what is a dirty wound?

Answer 17

old purulent wounds, foreign bodies, faecal contamination

Question 18

which clean wounds are more likely to result in infection?

Answer 18

surgeries with duration greater than 90 mins
placing of implants
inexperienced surgeon performing procedure

Question 19

what is one of the best defences against infection with clean-contaminated wounds?

Answer 19

antimicrobial prophylaxis according to anticipated flora

Question 20

how can we control degree of infection in contaminated wounds?

Answer 20

good management - lavage, debridement, targeted ab therapy (wound swab for C&S)

Question 21

when should antibiotics be used perioperatively?

Answer 21

inplant placement
surgery over 90 mins
clean-contaminated, contaminated and dirty procedures

Question 22

which factors contribute to selection of perioperative abs used?

Answer 22

always decision of VS
most likely a bacterial contaminant (staph, e. coli)
C&S results

Question 23

what is imperative about timing of perioperative abs?

Answer 23

ensure administered at most effective time (30 mins - 1 hour before surgery)

discontinue within 24 hours of completion of surgery (clean)

Question 24

what are the post-op care considerations to avoid infection?

Answer 24

sterile dressing for initial 24-48 hours - no evidence to support application after this period

remove drains ASAP

strict hand hygiene, kennel cleaning

monitor for signs of infection - patient demeanour, wound presentation, exudate

educate owners about signs of infection