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General Surgery > Post-op infections > Flashcards

Post-op infections Flashcards

1
Q

Define surgical site infection

A

A type of healthcare associated infection which occurs after an invasive surgical procedure.

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2
Q

Name 2 other healthcare associated infections that affect surgical patients

A

Post-op respiratory infection
Urinary tract infection
Bacteraemia
ABX-related diarrhoea

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3
Q

What are the 2 commonest causes of surgical site infection?

A

Patients own flora:
Skin - Staph aura, staph epidermidis
Viscera - E. coli (GI), Pseudomonas (biliary)

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4
Q

Name 4 sources of surgical infection

A 
Patient's own flora
Indirect contact
Direct inoculation
Airborne contamination
Haematogenous spread
Food and water
Faecal-oral
Insect bourne
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5
Q

What are the consequences of surgical site infection?

A

Increased morbidity and mortality
Extended hospitalisation
Cost

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6
Q

Name 2 pre-op measures to reduce surgical site infections

A

Patient shower before surgery
Hair removal using clippers
ABX prophylaxis when indicated

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7
Q

What are the indications for antibiotic prophylaxis in surgery?

A

Clean surgery involving insertion of prosthesis
Clean-contaminated surgery
Contaminated surgery

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8
Q

Name 2 intra-op measures to reduce surgical site infections

A

Antiseptic skin preparation
Hand decontamination and sterile gowns/gloves
Wound dressing

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9
Q

Name 2 post-op measures to reduce surgical site infections

A

Avoid unnecessary contact with wound for 48-72hr
Ensure clean hands and PPE
Involve tissue viability team if poor wound healing or infection
ABX if wound infected

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10
Q

Name 5 general risk factors for wound infection

A 
Age
Malnutrition
Obesity
Smoking
Immunosuppression
Diabetes mellitus
Alcoholism
Jaundice
Chronic kidney disease
Hypoxia and anaemia
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11
Q

Name 3 local risk factors for wound infection

A 
Type of surgery
Length of surgery
Necrotic tissue
Residual local malignancy
Foreign body
Ischaemia, haematoma
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12
Q

Name 2 microbiological risk factor for wound infection

A

Lack of ABX prophylaxis

Infectious organism

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13
Q

Name the 4 types of surgery

A

Clean
Clean contaminated
Contaminated
Dirty

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14
Q

What is the rate of surgical site infection for clean surgery?

A

<2%

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15
Q

What is the rate of surgical site infection for clean contaminated surgery?

A

<10%

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16
Q

What is the rate of surgical site infection for contaminated surgery?

A

15-20%

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17
Q

What is the rate of surgical site infection for dirty surgery?

A

> 40%

18
Q

Name 3 of the commonest bacteria seen with surgical site infections

A 
Coagulase -ve staph e.g. Staph epidermidis (25%)
Enterococci (11.5%)
Staph aureus (9%)
Candida albicans (6.5%)
E. coli (6.3%)
Pseudomonas aeruginosa (6%)
19
Q

Define clean surgery

A

An uninfected operative wound
No inflammation
Respiratory, GI, biliary, or genitourinary tract not entered

20
Q

Define clean-contaminated surgery

A

Operative wound
Respiratory, GI, biliary, or genitourinary tract entered under controlled conditions
No unusual contamination

21
Q

Define contaminated surgery

A

Open, fresh, or accidental wounds (<4hr)
Operations with major breaks in sterile technique or gross spillage from GI tract
Acute, non-purulent inflammation

22
Q

Define dirty surgery

A

Old (>4hr) traumatic wounds with retained devitalised tissue, and those that involve existing clinical purulent infection

23
Q

What are the 3 types of surgical site infection?

A

Superficial
Deep
Organ space

24
Q

Define wound dehiscence

A

A surgical complication in which a wound ruptures along a surgical incision.

25
Q

What is a complication of wound dehiscence of the abdomen?

A

Evisceration - viscera protrude through the wound

26
Q

What is the commonest cause of wound dehiscence?

A

Secondary to surgical site infection

27
Q

Outline the management of wound dehiscence

A

Initial: dress any exposed viscera, IV ABX if infected, drain pus

Superficial: regular lavage and dressing, consider vacuum-assisted closure

Deep: re-suture, vacuum-assisted closure

28
Q

What are the symptoms of surgical site infection?

A

Pain and discharge in wound

Malaise, anorexia, fever

29
Q

What are the signs of surgical site infection?

A

Fever, tachycardia
Red, swollen, tender wound
May be discharging pus

30
Q

What factors increase the risk of post-op sepsis?

A

Immunosuppressed patient

ABX-resistant organism

31
Q

What investigations should be sent in surgical site infection?

A

MCS of pus
FBC (Hb, WCC)
Blood cultures

32
Q

What is the initial management of surgical site infections?

A

Appropriate ABX guided by microbiologist

33
Q

Why are post-op respiratory infection common?

A

General anaesthetic irritates the respiratory tract.
Opioid analgesia inhibits cough reflex
Wound pain makes breathing and coughing more difficult

34
Q

How are post-op respiratory infections treated?

A

Good analgesia post-op
Chest physiotherapy
Antibiotics

35
Q

What is the most likely cause of post-op UTIs?

A

Catheter insertion

36
Q

How long should a catheter remain in a patient?

A

Up to 4-5 days

37
Q

How are post-op UTIs prevented?

A

Avoiding unnecessary catheterisation
Good aseptic technique
Remove at earliest time

38
Q

What is the role of catheters during/after a surgical procedure?

A

Monitor fluid output to ensure adequate hydration and removal of metabolites.

39
Q

What is the target urine output for the average patient?

A

0.5 ml/kg/hr

40
Q

Which organism is associated with antibiotic-related diarrhoea

A

Clostridium difficile

41
Q

Name 3 risk factors for C. difficile infection

A 
Current or recent ABX use
Over 65
Recurrent or prolonged admission
Nursing home
Serious co-morbidites
Immunosuppression
42
Q

Outline the management of C. difficile infection

A 
Isolation
Fluids and electrolytes
Monitor daily
Stop causative ABX
Avoid work/school for 48hr after last episode

Mild: no specific ABX Tx

Mild-moderate: Metronidazole 500mg TDS for 10-14 days

Severe/recurrent: Vancomycin

General Surgery (23 decks)

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