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Medicine II: Surgery > Surgical Infections > Flashcards

Surgical Infections Flashcards

1
Q

Pathogens vs Commensals

A

Concept of host defenses

A commensal could become a pathogen if it entered a sterile body cavity at time of surgery

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2
Q

Aerobes and Anaerobes

A

Can synergize with soft tissue infections and intra abdominal infections
Therapy is directed by both

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3
Q

Most surgical infections are caused by?

A

Polymicrobials

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4
Q

What are the host’s defenses?

A 
Skin and mucosa
Microflora of Resp. and GI tract
Stomach pH
Lactoferin and Fe chelators
Innate immune system (macrophages)
Adaptive immune system (T cells and B cells)
Omentum
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5
Q

Why are surgical infections becoming a rising problem?

A

emerging resistant organisms
changing patient population (immunosupression and sicker patients in the ICU)
larger more invasive operations

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6
Q

Local manifestations

A

Fever
elevated WBC
tachycardia and tachypnea
altered mental status

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7
Q

What are the outcomes of microbial invasion?

A 
erradication
containment
locoregional infection
metastatic abscess
systemic infection
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8
Q

What are examples of containment?

A

Abscess, pus, intermittent drainage

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9
Q

What are examples of locoregional infections?

A

cellulitis
lymphangitis
aggressive soft tissue infection

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10
Q

What are the types of surgical infections?

A

Soft tissue infections
Body cavity infections
Hospital acquired infections

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11
Q

What is significant about body cavity infections?

A

Usually iatrogenic (surgery), hard to see, no outward wound

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12
Q

Dehiscence

A

A surgical complication in which a wound breaks open along surgical suture. Risk factors are age, diabetes, obesity, poor knotting or grabbing of stitches, and trauma to the wound after surgery.

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13
Q

Evisceration

A

fascia falls apart, gut falls out of abdomen, surgical issue

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14
Q

Cellulitis

A

A diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin.

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15
Q

Gangrene

A

A serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies after an injury, infection or ischemia, will not be treated with antibiolics since no blood flow goes to dead tissue

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16
Q

Abscess

A

A collection of pus in a newly formed cavity in any part of the body that is accompanied by swelling and inflammation.

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17
Q

Bacteremia

A

The presence of viable bacteria in the circulating blood that may or may not have any clinical significance;

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18
Q

Sepsis

A

response to infection, manifests as an increase in HR and a decrease in BP with a change in mental status

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19
Q

Cellulitis Treatment

A

Drainage of focal source, antibiotics, local wound care and control of complicating factors.
The underlying source of infection has to be removed
If abscess or necrotic tissue, cath and treat with antibiotics

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20
Q

Abscess Treaatment

A

Most commonly inappropriatley treated; many just give antibiotics BUT if there is pus you have to get it out!
Need to drain with a proper incision and then close it up from the bottom to avoid reformation
Abx not indicated for a straight forward abscess
complicating factors make a huge difference in how patient reacts to treatment

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21
Q

Necrotizing Fascitis

A

Flesh eating bacteria that spreads quickly along fascial planes with in minutes to hours

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22
Q

How do you treat necrotizing fascitis?

A

Have to treat aggressively, 1st surgical debridement. May have to amputate
Make a wide surgical debridement and treat with broad spectrum antibiotics, supportive care
May need serial debridements

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23
Q

Risk factors for a UTI

A

Instrument- foley (most common cause)
Elderly or debilitated
Pregnant
Urologic abnormalities

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24
Q

Treatment of a UTI

A

Antibiotics, early catheter removal and evaluate for complicating factors

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25
Q

Pneumonia- Hospital Acquired

A

Inhibition of normal cough reflex, can be due to anesthesia, narcotics, pain, ET intubation

Pt presents with fever, dyspnea, etc

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26
Q

How do you diagnose a patient with HA pneumonia?

A

No one thing:

elevated WBC, excess fluid accumulates in the lung bases (atelectasis), decrease in breath sounds, CXR findings, Hypoxia

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27
Q

What is a common cause of HA pneumonia?

A

Ventilators- bacteria grows in the lines

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28
Q

What is the treatment for HA pneumonia?

A

Antibiotics and breathing support

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29
Q

How do we prevent HA pneumonia?

A

early extubation, incentive spirometry/chest PT, OOB, oropharyngeal decontamination w/topical abx, limit narcotics

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30
Q

Intravenous catheter related infections

A

central venous lines vs peripheral IV lines

microorganisms from skin follow catheter into bloodstream

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31
Q

Main causative agents of IV cath related infections?

A

S. aureus and S. epidermis

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32
Q

What are the risks of IV cath related infections?

A 
duration of cath
number of cath manipulations
violations of aseptic technique
multi-lumen caths
nontransparent bandages
33
Q

How do we diagnose IV cath related infections?

A

frank pus around cath site
cellulitis around cath insertion
culture of blood from cath

34
Q

How do we treat IV cath related infections?

A

remove cath, culture blood, cath free break, ABX, reinsert new cath

35
Q

Surgical infections prevention includes:

A

good surgical technique

antibiotic prophylaxis

36
Q

Good surgical technique

A

gentle traction, hemostasis, removal of devitalized tissue, no dead space, irrigation, monofilament vs braided suture, no tension and closed suction

37
Q

Antibiotic prophylaxis

A

eradicate/retard growth of endogenous organisms
must be w/in 1 hr window prior to incision time
Cefazolin- most clean procedures

38
Q

What antibiotic prophylaxis do you use in bowel surgery?

A

Cefazolin/metronidazole OR cefotetan

39
Q

What antibiotic prophylaxis do you use in an appendectomy or biliary tract surgery?

A

Timentin

40
Q

What antibiotic prophylaxis do you use for a penicillin allergy?

A

Clindamycin or Levofloxacin

41
Q

What antibiotic prophylaxis do you use for in-patients?

A

Vancomycin

42
Q

Where else do we use vancomycin?

A

prevention of MRSA
prosthtic valves and vascular grafts
History of broad spectrum antibiotic therapy
preoperative study longer than 1 week in the hospital

43
Q

With the removal of hair, what does shaving increase?

A

SSI

44
Q

How do we prevent this with hair removal?

A

Remove just prior to incision

use clippers or creams

45
Q

What do we do if our patient develops hyperglycemia?

A

Tight glucose control below 150

continuous iv insulin decrease SSI and better than SQ

46
Q

What is perioperative normothermia? And how do we prevent it?

A

vasoconstrictibe response leading to skin ischemia

a temperature above 36.5 C reduces the risk of a SSI

47
Q

What is a SSI?

A

Surgical site of infection- infections related to the operative procedure that occur near or at the surgical incision w/in 30 days of a year if an implant is left

48
Q

What are the top two most common nosocomial infections?

A

UTIs

SSIs

49
Q

What is the breakdown of incidence of SSIs in non-teaching vs teaching hospitals?

A

non: 4.6
small teaching: 6.4
large teaching: 8.2

50
Q

What classifies an incisional deep SSI?

A

Surgical site of infection w/in 30 days of a year if an implant is left, that involves deep soft tissues, fascia, and muscle and at least 1:
purulent drainagge
fever >38C, spontaneous or intentional wound opening, pain and localized tenderness
visual, radiological or histological evidence of an abscess
surgeons diagnosis

51
Q

What classifies an organ/space SSI?

A

Surgical site of infection w/in 30 days of a year if an implant is left, that involves any part of the anatomy list that was manipulated and at least 1:
purulent drainage from the rgan/space
positive culture
visual, radiological or histological evidence of organ/space
surgeons diagnosis

52
Q

What are the procedure types and their corresponding degrees of contamination?

A

clean- <3% infection rate
clean contaminated- 1-3% infection rate
contaminated - 6.4-15.2% infection rate
dirty- up to 40% infection rate

53
Q

Clean

A 
a surgical procedure with prepped skin
not infected
no pre existing skin inflammatioin
no resp, GI or GU tract involved
primary closure
54
Q

What are organisms that can cause an infection in a clean procedure?

A

S. aureus and S. epidermis

55
Q

What are examples of a clean procedure?

A

hernia, thyroidectomy, vagotomy, neurosurgery

56
Q

Clean-contaminated

A

A surgery involving the resp, GI or GU tract
mechanical and antibacterial preparation
no evidence of active infection
minor sterile technique errors

57
Q

What are organisms that can cause an infection in a clean-contaminated procedure?

A

endogenous flora

58
Q

What are examples of a clean-contaminated procedure?

A

cholecystectomy, appendectomy, colonic resection, adenoidectomy

59
Q

Contaminated

A 
involves a surgery with an acute non-purulent inflammation
traumatic open wound
major failure of sterile technique
significant GI leak (colonic, biliary)
secondary or delayed closure
60
Q

What are organisms that can cause an infection in contaminated procedure?

A

endogenous flora

61
Q

What are examples of a contaminated procedure?

A

gangrenous cholecystitis, enterectomy

62
Q

Dirty

A 
a surgery that involves an old traumatic wound (except in the face) >6hr
necrotic or infected wound
hollow organ perforation
active infection
delayed closure
63
Q

What are organisms that can cause an infection in a dirty procedure?

A

mixed

64
Q

What are examples of a dirty procedure?

A

perforated abscess, perforated diverticulitis, infected mesh

65
Q

What are surgical management techniques in the acute care setting?

A

resuscitate
open wound
obtain cultures from deeper wound
antibiotic therapy

66
Q

What are surgical management techniques in the long-term care setting?

A

improve patient condition
dry vs moist dressing changes
wound VAC

67
Q

What are the classifications of wounds by color?

A 
pink
red
yellow
green
black
68
Q

What is a red classification?

A

granulated

69
Q

What is a pink classification?

A

epithelialized

70
Q

What is a yellow classification?

A

needs debridement

71
Q

What is a green classification?

A

infection/Pseudomonas

72
Q

What is a black classification?

A

necrosis

73
Q

What classification is the ultimate goal in wound care?

A

granulated

74
Q

What are side effects of dry dressing changes?

A

contact dermatitis and skin damage

75
Q

What are side effects of moist therapy?

A

bleeding
hypergranulation
skin maceration
allergic reactions

76
Q

What are types of moist therapy?

A 
opsite/tegaderm
hydrocolloids, hydropolymers, hydrocellular
hydrogels
calcium/collagen alginates
activated charcoal/silver alginates
collagenase
77
Q

What is a VAC?

A

vacuum assisted closure

78
Q

Emphyema

A

A collection of pus within a naturally existing anatomical cavity, such as the lung pleura.

79
Q

Septicemia

A

Septicemia is bacteria in the blood that often occurs with severe infections and may be life-threatening.

Medicine II: Surgery (14 decks)

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