Perioperative Infection Control Flashcards
what is a surgical site infection?
a type of hospital-acquired infection (HAI)
in which timeframe can a HAI occur?
from when patient goes into hospital up to 30 days post-discharge
what are the complications of SSIs?
poor healing, delayed healing time
increased medical costs
possible revision surgery
damage to client relationships
poorer patient welfare
increased antibiotic use
what are the 5 steps that should be taken if a SSI is suspected?
identify infection
assess extent of infection
begin culture-based antibiosis
good wound management
good infection control techniques
what are exogenous factors for infection?
from a source outside the patient e.g. surgeon, equipment, environment
what are endogenous factors for infection?
most common is patients own skin flora
what are the 3 main types of factors predisposing patients to infection?
patient factors
environmental factors
treatment factors
what patient factors can predispose a patient to infection?
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
which environmental factors can predispose a patient to infection?
poor patient prep - consider surround area, products
cross-contamination
theatre conduct - personnel, attire
theatre cleaning methods
inadequate ventilation
what treatment factors might predispose a patient to infection?
surgical time - risk increases linearly
surgeon experience
inadequate ab prophylaxis
drain placement
emergency procedures
surgical implants
suture material selection
what is the most important aspect of infection control?
hand hygiene
when should we be washing our hands?
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
what are the 4 surgical wound classifications?
clean
clean-contaminated
contaminated
dirty
what is a clean wound?
non-traumatic wounds that do not involve the opening of respiratory, GI, genourinary or oropharyngeal tracts
what is a clean-contaminated wound?
surgical wounds which involve entering the respiratory, GI, genourinary or oropharyngeal tracts in controlled conditions or placement of a drain
what is a contaminated wound?
open wounds
spillage of GI contents/infected urine
break in aseptic technique
what is a dirty wound?
old purulent wounds, foreign bodies, faecal contamination
which clean wounds are more likely to result in infection?
surgeries with duration greater than 90 mins
placing of implants
inexperienced surgeon performing procedure
what is one of the best defences against infection with clean-contaminated wounds?
antimicrobial prophylaxis according to anticipated flora
how can we control degree of infection in contaminated wounds?
good management - lavage, debridement, targeted ab therapy (wound swab for C&S)
when should antibiotics be used perioperatively?
inplant placement
surgery over 90 mins
clean-contaminated, contaminated and dirty procedures
which factors contribute to selection of perioperative abs used?
always decision of VS
most likely a bacterial contaminant (staph, e. coli)
C&S results
what is imperative about timing of perioperative abs?
ensure administered at most effective time (30 mins - 1 hour before surgery)
discontinue within 24 hours of completion of surgery (clean)
what are the post-op care considerations to avoid infection?
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
