Surgical Care Flashcards
What is a surgical site infection?
An infection that occurs in the incision created by an invasive surgical procedure
There are 4 main types of surgery depending on cleanliness. What are they?
- Clean
- Clean contaminated
- Contaminated
- Dirty
What is a clean surgery? Give some examples
- incision in which no inflammation is encountered in a surgical procedure,
- no break in sterile technique
- respiratory, alimentary and genitourinary tracts are not entered.
- Hernia repair
- mastectomy
- AAA
What is clean-contaminated surgery? List some examples
- incision through which the respiratory, alimentary or genitourinary tract is entered
- Cholecystectomy
- Appendectomy
- Bowel resection
What is a contaminated surgery? List some examples
- incision undertaken during an operation in which there is a major break in sterile technique
- gross spillage from the gastrointestinal tract
- acute, non-purulent inflammation is encountered.
- Open traumatic wounds that are more than 12–24 hours
- Chole c bile spillage
- Appendectomy of perforated appendix
What is a dirty surgery? List some examples
- incision undertaken during an operation in which the viscera are perforated
- acute inflammation with pus is encountered
- Abscess drainage
- Debridement of necrotising soft tissue
What are the RF (patient factors) for SSI?
- extreme age
- poor nutritional status
- DM
- RF
- Immunosuppresed
- Smoker
What are the RF (operation factors) for SSI?
- Length of operation
- preoperative shave
- foreign material in surgical site
- surgical drain insertion
- poor wound closure
How many days post op does SSI typically appear?
5-7 days
What are the clinical features of SSI?
- spreading erythema
- localised pain
- pus discharge
- wound dehiscence
- persistent pyrexia
What Ix would you perform for SSI
Bedside
- wound swabs
- blood test - inflammatory markers
How would you mx SSI?
- Remove sutures or clips - allow drainage
- Empirical abx
*
There are 3 phases of preventing SSI. What would you do in the preoperative phase?
- Prophylactic abx
- Shower before surgery
- Encourage weightloss and optimise nutrition
There are 3 phases of preventing SSI. What would you do in the intraoperative phase?
- Apply povidone-iodine or chlorhexidine on skin at surgical site
- change gloves or gown if contaminated
- Use interactive dressing at end of operation
There are 3 phases of preventing SSI. What would you do in the postoperative phase?
- Monitor wounds closely
- Refer to tissue viability nurse for advice on wound dressing
- Topical abx
What is Necrotising Fasciitis?
- Infection of soft tissue and fascia
What is the Px of NF?
- Infection starts at superficial fascia
- Organism release enzymes and proteins causing necrosis of fascial layer
- Infection spreads vertically up to skin and down to deeper tissue
- Thrombosis occludes arteries and veins
- Ischaemia > necrosis of soft tissue
What organisms commonly cause NF?
Type 1 NF
- Staph aureus
- Haemophilus
- E.Coli
Type 2 NF
- Haemolytic group A Streptococci (GAS) - Strep pyogenes
- MRSA
Type 3 NF
- Clostridia Perfringens
What are the RF of developing NF?
- Immunocompromise
- Obesity
- Diabetes
- Advance age
- Drug abuse
- Chronic illness
- Aspirin
- NSAIDs
Where is the common area of developing NF?
- Lower limb (most common)
- Upper limb
- perineum
- buttocks
- trunk
What are the features of affected area?
- Swelling
- Purplish rash
- Large dark marks with dark fluid
- Blackened (necrosed) area
- oedema
- crepitus under skin - due to gas
*Sx occur after day 3-4
What will pt c NF experience after day 4-5?
- Severely pyretic
- Low BP
- Bacteremia
- Loss of conscioussness
What test can you perform to diagnose NF? Describe the test
- Finger test
- 2cm vertical incision made on affected area
- Index finger is pushed into tissue
- if the finger passes through subcutaneous tissue without resistance
What Ix would you order for NF
Bedside
- Bloods
- Inflammatory markers
- Urea
- Blood culture
- Deep tissue biopsy
Imaging
- Xray, CT, MRI
What is the Mx plan for NF?
- High dose IV antibiotics
- Iv fluids
- O2
- IV immunoglobulin
- Surgical debridement
*
What are the Cx of NF?
- Renal failure
- Septicaemia
What are the basic principles of wound management?
- Haemostasis
- Wound cleaning
- Analgesia
- Skin closure
- Dressing
- Follow up advice
What are the examples to achieve Hemostasis in wound Mx?
- pressure
- elevation
- torniquet
- suturing
What are the 5 aspects of wound cleaning?
- Disinfect skin around wound
- Decontaminate wound
- Debride any devitalised tissue
- Irrigate wound c saline
- Abx
What is the maximum level of lidocaine c and c/o adrenaline?
- c adrenaline
- 7mg/kg
- c/o adrenaline
- 3mg/kg
What are the 4 main methods of achieving skin closure?
- Skin adhesive strips (steri strips)
- Tissue adhesive glue (Indermil)
- Suture
- Staples
What are the 3 layers used in wound dressing?
- First layer
- Non adherent - saline soaked gauze
- Second layer
- absorbent material - attract wound exudate
- Third layer
- Soft gauze tape - secure dressing in place
What advice would you give to pt for initial wound mx?
- seek medical attention for signs of infection
- take simple analgesia
- keep wound dry as much as possible
- suture or strips removed after 10-14 days
