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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
Pneumonia- Hospital Acquired
Inhibition of normal cough reflex, can be due to anesthesia, narcotics, pain, ET intubation Pt presents with fever, dyspnea, etc
26
How do you diagnose a patient with HA pneumonia?
No one thing: | elevated WBC, excess fluid accumulates in the lung bases (atelectasis), decrease in breath sounds, CXR findings, Hypoxia
27
What is a common cause of HA pneumonia?
Ventilators- bacteria grows in the lines
28
What is the treatment for HA pneumonia?
Antibiotics and breathing support
29
How do we prevent HA pneumonia?
early extubation, incentive spirometry/chest PT, OOB, oropharyngeal decontamination w/topical abx, limit narcotics
30
Intravenous catheter related infections
central venous lines vs peripheral IV lines | microorganisms from skin follow catheter into bloodstream
31
Main causative agents of IV cath related infections?
S. aureus and S. epidermis
32
What are the risks of IV cath related infections?
``` duration of cath number of cath manipulations violations of aseptic technique multi-lumen caths nontransparent bandages ```
33
How do we diagnose IV cath related infections?
frank pus around cath site cellulitis around cath insertion culture of blood from cath
34
How do we treat IV cath related infections?
remove cath, culture blood, cath free break, ABX, reinsert new cath
35
Surgical infections prevention includes:
good surgical technique | antibiotic prophylaxis
36
Good surgical technique
gentle traction, hemostasis, removal of devitalized tissue, no dead space, irrigation, monofilament vs braided suture, no tension and closed suction
37
Antibiotic prophylaxis
eradicate/retard growth of endogenous organisms must be w/in 1 hr window prior to incision time Cefazolin- most clean procedures
38
What antibiotic prophylaxis do you use in bowel surgery?
Cefazolin/metronidazole OR cefotetan
39
What antibiotic prophylaxis do you use in an appendectomy or biliary tract surgery?
Timentin
40
What antibiotic prophylaxis do you use for a penicillin allergy?
Clindamycin or Levofloxacin
41
What antibiotic prophylaxis do you use for in-patients?
Vancomycin
42
Where else do we use vancomycin?
prevention of MRSA prosthtic valves and vascular grafts History of broad spectrum antibiotic therapy preoperative study longer than 1 week in the hospital
43
With the removal of hair, what does shaving increase?
SSI
44
How do we prevent this with hair removal?
Remove just prior to incision | use clippers or creams
45
What do we do if our patient develops hyperglycemia?
Tight glucose control below 150 | continuous iv insulin decrease SSI and better than SQ
46
What is perioperative normothermia? And how do we prevent it?
vasoconstrictibe response leading to skin ischemia | a temperature above 36.5 C reduces the risk of a SSI
47
What is a SSI?
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
What are the top two most common nosocomial infections?
UTIs | SSIs
49
What is the breakdown of incidence of SSIs in non-teaching vs teaching hospitals?
non: 4.6 small teaching: 6.4 large teaching: 8.2
50
What classifies an incisional deep SSI?
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
What classifies an organ/space SSI?
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
What are the procedure types and their corresponding degrees of contamination?
clean- <3% infection rate clean contaminated- 1-3% infection rate contaminated - 6.4-15.2% infection rate dirty- up to 40% infection rate
53
Clean
``` a surgical procedure with prepped skin not infected no pre existing skin inflammatioin no resp, GI or GU tract involved primary closure ```
54
What are organisms that can cause an infection in a clean procedure?
S. aureus and S. epidermis
55
What are examples of a clean procedure?
hernia, thyroidectomy, vagotomy, neurosurgery
56
Clean-contaminated
A surgery involving the resp, GI or GU tract mechanical and antibacterial preparation no evidence of active infection minor sterile technique errors
57
What are organisms that can cause an infection in a clean-contaminated procedure?
endogenous flora
58
What are examples of a clean-contaminated procedure?
cholecystectomy, appendectomy, colonic resection, adenoidectomy
59
Contaminated
``` 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
What are organisms that can cause an infection in contaminated procedure?
endogenous flora
61
What are examples of a contaminated procedure?
gangrenous cholecystitis, enterectomy
62
Dirty
``` 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
What are organisms that can cause an infection in a dirty procedure?
mixed
64
What are examples of a dirty procedure?
perforated abscess, perforated diverticulitis, infected mesh
65
What are surgical management techniques in the acute care setting?
resuscitate open wound obtain cultures from deeper wound antibiotic therapy
66
What are surgical management techniques in the long-term care setting?
improve patient condition dry vs moist dressing changes wound VAC
67
What are the classifications of wounds by color?
``` pink red yellow green black ```
68
What is a red classification?
granulated
69
What is a pink classification?
epithelialized
70
What is a yellow classification?
needs debridement
71
What is a green classification?
infection/Pseudomonas
72
What is a black classification?
necrosis
73
What classification is the ultimate goal in wound care?
granulated
74
What are side effects of dry dressing changes?
contact dermatitis and skin damage
75
What are side effects of moist therapy?
bleeding hypergranulation skin maceration allergic reactions
76
What are types of moist therapy?
``` opsite/tegaderm hydrocolloids, hydropolymers, hydrocellular hydrogels calcium/collagen alginates activated charcoal/silver alginates collagenase ```
77
What is a VAC?
vacuum assisted closure
78
Emphyema
A collection of pus within a naturally existing anatomical cavity, such as the lung pleura.  
79
Septicemia
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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