SSI ( surgical site infection) Flashcards
surgical site infection
ssi occur when pathogenic organism multiply in the surgical wound cauing local or systemic sign and symptoms
25% of all nosocomical infection are wound infections
2% - 5% of patients undergoing clean extra-abdominal operations & 20% undergoing intra-abdominal operations will develop SSI
how to prevent SSI
1- antibiotic prophylaxis, but not the only strategy
2- optimal perioperative medical management
3- adequate debridment
4- good surgical tehcniques
patient risk factors of infection in surgery
- extremes of age
- imunocompromised patient
- co existing infection at other site
- carriage of resistant organism like mrsa
- diabetes meliitus
- smoking
- prolong hospital stay
- poor nutritional status and obesity
procedural risk factors of infection in surgery
- surgical techinque
- adequate hemostasis
- maintainng body temperature
- skin antisepsis
- operational theatre ventilation and air changes
- presence of forign body, tissue truama or shaving preoperaitve
clean
- No entry into GI, respiratory, GU, or biliary tracts.
- No acute inflammation.
- No break in aseptic technique.
- Elective procedures.
* Infection Rate: >5% - Example: Routine orthopedic surgery.
Clean-Contaminated:
- Controlled entry into GI, respiratory, GU, or biliary tracts.
- Minimal spillage.
- Break in sterile technique (major).
* Infection Rate: >10% - Example: Elective cholecystectomy.
contaminated
Acute, non-purulent inflammation present.
Major spillage or technique break.
Infection Rate: 15-20%
Example: Emergency bowel surgery with spillage.
Dirty:
- Preexisting infection present (abscess, pus, necrotic tissue).
- Infection Rate: 30-40%
- Example: Surgery for an abscess or infected wound.
extra-abdominal operations
usually considered clean
1. cause by skin flora organism
2. pathogens gram + include:
* streptococcus aureus
* Staphylococcus epidermidis
intra abdominal infections
clean contaminated
infection Source: Diverse flora with the potential for polymicrobial infections.
1. escherchia coli
2. gram - bacteria
3. anaerobes (especially Bacteroides spp
Ideal criteria for an antimicrobial in surgical prophylaxis include the following:
- Spectrum that covers expected pathogens
- Inexpensive
- Parenteral
- Easy to use
- Minimal adverse-event potential
- Longer half-life to minimize need for re-dosing during procedure
antimicrobial prophylaxis
A regimen for antimicrobial prophylaxis ideally involves one agent and lasts less than 24 hours.
use in Clean clean contaminated and contaminated
not used in dirty bcz its need treatment not prophylaxis
Scheduling Antibiotic Administration
Goal: Ensure the antibiotic reaches bactericidal concentrations at the surgical site before the incision is made.
timing Complete iv administration within 60 minutes before the incision, preferably 15-30 minutes before.
early admin: decrease the MIC at end of procedure
late administration: leave the patient unprotected at the critical initial incision time
during surgey: intraoperative doses may be required.
Antibiotics for extra-abdominal operations
Preferred Antibiotic: Cefazolin for its low cost, simple dosing and low adverse event profile
In case of a β-lactam allergy, clindamycin or vancomycin can be used as alternative.
Administration: Iv for complete bioavalibility
Antibiotics for intra - abdominal operations
Antianaerobic cephalosporins e.g. CEFOXITIN or CEFOTETAN, are widely used.
In case of β-lactam allergy, fluoroquinolones or aminoglycosides in combination with clindamycin or metronidazole, provide adequate coverage for intra-abdominal operations.
