Perioperative Infection Control

Question 1

What is a surgical site infection?

Answer 1

a type of hospital acquired infection

Question 2

What is the time frame for a hospital acquired infection?

Answer 2

day patient goes into hospital up to day 30 post discharge

Question 3

How cab surgical site infections develop?

Answer 3

• poor handling, delyaed healing time
• increased medical costs
• possible revision surgery
• client relationships
• patient welfare
• increased antibiotic use
• poor tissue joining

Question 4

What is an exogenous infection?

Answer 4

infection caused by something outside the patient e.g the surgeon, equipment, environment

Question 5

What is an endogenous infection?

Answer 5

caused by the patients skin flora and most common SSI

Question 6

What does infection require?

Answer 6

introduction of microorganisms into the surgical wound

Question 7

Patient factors predisposing infection?

Answer 7

• body condition/age - if patient over 10 poor immune response, under 1 year underdeveloped immune system
• malnutrition - decreaased albumin levels
• immunosuppressed/endocrinopathies - medical therapy e.g steroids, diabetes mellitus
• remote infection - seeding of infection, bacterial already in blood stream
• skin diseasse - bacterial from the skin
• recent operation
• prior site radiation
• perioperative temperature

Question 8

Environmental factors predisposing injection

Answer 8

• patient preparation
• cross contamination
• aseptic technique
• theatre conduct - personnel, attire
• cleaning methods
• inadequate ventilation

Question 9

Treatment factors predisposing infection

Answer 9

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

Question 10

When should you wash hands?

Answer 10

• BEFORE and AFTER touching a patient
• EFORE and AFTER touching surroundings
• BEFORE carrying out aspetic techniques
• BEFORE glocing
• AFTER possible exposure to contaminated fluids/tissues

Question 11

What is a clean sugical wound?

Answer 11

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

Question 12

What are clean-contaminated wounds?

Answer 12

surgical wounds which involve entering the respiratory, GI, genitourinary or oropharyngeal tract

Question 13

What are contaminated wounds?

Answer 13

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

Question 13

What is a dirty wound?

Answer 13

old purulent wounds, foreign bodies, faecal contamination

Question 14

What is an example of a dirty wound?

Answer 14

dog bite, stick injury, RTA, if surgeon going into infected skin

Question 15

What is an example of a clean wound?

Answer 15

a planned surgery

Question 16

What is an example of a clean contaminated wound?

Answer 16

placing a drain, oesophageal surgery

Question 17

What is the published infection rate of a clean wound?

Answer 17

0-4.4%

Question 18

When are clean wounds likely to become infected?

Answer 18

surgery longer than 90 minutes, implants, inexperienced surgeon

Question 19

What is the published infection rate for clean contaminated wounds?

Answer 19

4.5-9.3%

Question 20

What is the published infection rate for contaminated wounds?

Answer 20

5.8-28.6%

Question 21

How can you prevent infection of a contaminated wound?

Answer 21

lavage, debridements, food antibiotic therapy

Question 22

When should antibiotics be used?

Answer 22

• if implants are being used
• surgery over 90 minutes
• clean/contaminated, contaminated, dirty procedures

Question 23

When is the most effective time to give antibiotics?

Answer 23

30mins-1hr pre-surgery

Question 24

Post-operative care to prevent infections?

Answer 24

• apply sterile dressing for first 24-48hrs
• remove drains as soon as possible
• strict hygiene
• nutrition and monitor
• monitor for exudate, strike through, appearance of exudate