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Surgery > Surgical Infections > Flashcards

Surgical Infections Flashcards

1
Q

T/F: Most surgical infections are polymicrobial (anaerobes and aerobes).

A

True

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2
Q

A class of relationship between two organisms where one organism benefits without affecting the other.

A

Commensalism

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3
Q

Host Defenses

A
  1. Skin and mucosa
  2. Microflora
  3. Mucus
  4. Stomach pH
  5. Lactoferrin and Iron Chelators
  6. Complement System
  7. Innate Immune System (macrophages)
  8. Adaptive Immune System (T cells, B cells)
  9. Omentum
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4
Q

Why is surgical infection a growing problem?

A
  1. Emerging Resistant Organisms
  2. Changing patient population – sicker patients, immunosuppressed patients
  3. Larger, more invasive procedures – Sx implants
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5
Q

For any given operation, the development of a wound infection will approximately ______ the cost of hospitalization.

A

Double

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6
Q

Systemic Manifestations of Infections

A
  1. Local Manifestations
  2. Fever (385 deg Celsius/ Immunosuppressed patients)
  3. Elevated WBC
  4. Tachycardia
  5. Tachypnea
  6. Altered Mental Status
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7
Q

What are the possible outcomes of a microbial invasion?

A
  1. Eradication
  2. Containment (i.e. abscess, pus, intermittent drainage)
  3. Locoregional Infection (i.e. cellulitis, lymphangitis, agressive soft tissue infection
  4. Metastatic Abscess
  5. Systemic Infection
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8
Q

Examples of Soft Tissue Infections

A
  • Cellulitis

- Necrotizing Infection

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9
Q

Examples of Body Cavity Infections

A
  • Peritonitis
  • Intra-abdominal abscess
  • Empyema
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10
Q

Examples of Hospital-acquired Infections

A
  • Wound Infections
  • UTIs
  • Pneumonia
  • Catheter-related
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11
Q

Term for a surgical complication in which a wound ruptures along surgical suture.

A

Dehiscence

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12
Q

An _______ removes the internal contents of the eye and leaves the sclera to prevent spread of the infection?

A

Evisceration

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13
Q

This is a localized or diffuse inflammation of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin.

A

Cellulitis

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14
Q

This is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies (necrosis). This can be wet or dry (wet is more serious)

A

Gangrene

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15
Q

This is a collection of pus in any part of the body that, in most cases, causes swelling and inflammation around it.

A

Abscess

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16
Q

This is the presence of bacteria in the blood.

A

Bacteremia

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17
Q

This is a potentially fatal whole-body inflammation (a systemic inflammatory response syndrome or SIRS) caused by severe infection.

A

Sepsis

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18
Q

Risk Factors for a UTI

A
  • Instrumentation (Foley)
  • Elderly or debilitated
  • Pregnancy
  • Urologic Abnormalities
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19
Q

What should you do with a Foley cath?

A

Use it only when necessary and only as long as necessary.

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20
Q

Pneumonia is more common when there is a _________.

A

Inhibition of normal cough, such as with anesthesia, narcotics, pain, or ET intubation

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21
Q

Signs of Pneumonia/Recumbency

A
  • Excess fluid accumulates at lung bases (atelectasis)
  • Decreased breath sounds, crackles
  • CR Findings
  • Hypoxia
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22
Q

How do you prevent pneumonia?

A
  • Early extubation
  • Incentive Spirometry/ Chest PT
  • OOB
  • Oropharyngeal decontamination with topical antibiotics
  • Limit Narcotics
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23
Q

Best treatment for a pneumonia

A

Abx

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24
Q

Common IV Catheter-related infections

A

S. aureus

S. epidermidis

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25
Q

Risks of IV Catheter-related infections

A
  • Duration of catherization
  • Number of catether manipulations
  • Violations of catether manipulations
  • Multi-lumen catheters
  • Transparent dressings (vs. simple gauze)
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26
Q

How do you diagnose an IV Catheter-related infection?

A
  • Frank pus around catheter site
  • Cellulitis around catheter insertion
  • Culture of blood from catheter
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27
Q

How do you treat an IV Catheter-related infection?

A
  • Remove catheter
  • Culture blood (not catheter tip)
  • Catheter Free Break
  • Abx
  • Reinsert New Line
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28
Q

Patient Related Risk factors for surgical infection

A
  • Pre-op admission
  • Concomitant infection
  • DM
  • Obesity
  • Age
  • Immune Response
  • Abdominal Sx
  • Malnutrition: Albumin > 2.5, Prealbumin
  • Smoking
  • Ischemia
  • Nasal Carrier
  • Chemo/Radiotherapy
  • Steroids/Immunosuppressive
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29
Q

Perioperative Risk factors for surgical infection

A
  • Abx prophylaxis
  • GI preparation
  • Surgical time
  • OR ventilation/personnel traffic
  • Hair Removal
  • Foreign Material
  • Patient Scrubbing
  • Steilization Techniques
  • Drains
  • Antisepsis
  • Blood transfusion
  • Surgical Scrubbing
  • Surgical Technique (Burn, Hemostasis, Trauma)
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30
Q

How can you prevent surgical infections?

A
  • Improve patients general health
  • Operative Technique
  • Preoperative Abx
  • Preop showering with antimicrobial soap
  • Skin antiseptics
  • Washing and Gloving
  • Sterile Drapes
  • Gowns and Masks
31
Q

Surgical Hand Hygiene can also prevent surgical infection. How?

A
  1. Preop washing to the elbows
  2. Using antiseptic soap
  3. Using Aqueous Alcohol
  • **Hand rubbing and hand scrubbing have similiar SSI rated.
  • **Hand rubbing better tolerated and more complications
32
Q

How does abx prophylaxis prevent surgical infection?

A
  • Eradicate/retard the growth of endogenous organisms
  • Must be within a 1 hour window prior to incision time
  • Most clean procedures do no require it, but CABG, Prosthesis, Laminectomy
33
Q

What are the common abx used for abx prophylaxis in Abx Prophylaxis?

A
  1. Cefazolin – most clean procedures
  2. Cefuroxime – Thoracic and Ortho Sx
  3. Cefotetan (Cefazolin/Metro) – Bowel Sx
  4. Timentin – Appendectomy, Biliary Tract Sx
  5. Clindamycin or Levo – PCN allergy
  6. Vancomycin – Prevent MRSA in centers with high prevalence, prosthetic valves and vascular grafts, hx of broad-spectrum abx therapy, preoperative stay longer than 1 week in the hospital.
34
Q

When should you give prophylactic abx?

A

Within 1 hour (30 min window)

35
Q

When do you redose antibiotics?

A
  • Every 1 half life (not routinely
  • Indication: > 4 hours, Major Blood loss
  • D/c within 24 hours or 48 if cardiac
36
Q

Surgical Prevention in Colorectal Surgery:

A
  1. Preop IV antibiotic prophylaxis
  2. Bowel Preparation ABx (Oral neomycin + erythromycin/metro)
  3. Bowel Mechanical Prep: Golytely, Magnesium Citrate, Phospho-soda
37
Q

How do we decontaminate the nose as a preventative measure?

A
  1. Intranasal Mupirocin

2. Intranasal chlorhexidin fluconate to reduce in MRSA carriage. No data on this

38
Q

Hair removal is a surgical infection prevention method.

A

Shaving increases SSI, so remove it just prior to incision using clippers or creams, if you need to.

Shaving is allowed for skin grafts.

39
Q

How do we prevent complications with hyperglycemia?

A
  1. Tight glucose control below 150 mg/dL
  2. Continuous IV insulin decreased SSI and bette than SQ
  3. Each 50 mg/dL above nl increased NHS
40
Q

Vasocontrictive response can lead to what?

A

Skin ischemia

41
Q

What temperature should the OR be at to reduce the risk of SSI?

A

36.5 Celsius +

42
Q

This is the term used for tissue loss at the skin caused by a traumatic or surgical incision.

A

Wound

43
Q

This is a term used for infections related to the operative procedure that occurs at or near the surgical incision within 30 days or within a year if an implant is left.

A

Surgical Site Infection

44
Q

How do you classify SSI?

A
  1. Incisional (Superficial vs. Deep)

2. Organ/Space

45
Q

Which type of SSI is more serious/expensive?

A

Organ/Space

46
Q

This is a type of SSI that is involves the skin and SQ tissue and at least one of the following:

a. Purulent drainage
b. Wound opening by surgeon
c. Positive Culture
d. Surgeon’s Dx

A

Incisional Superficial SSI

47
Q

Exclusion criteria for Incisional Superficial SSI

A
  • Suture Abscess
  • Infected Episiotomy
  • Infected Neonatal Circumcision
  • Infected Burn
48
Q

This is a type of infection that involves the deep soft tissues, fascia, and muscle of an incision and at least one of the following:

a. Purulent Drainage
b. Fever >38 deg C
c. Spontaneous or intentional wound opening, pain, and localized tenderness
d. Visual, radiographical or histological evidence of an abscess
e. Surgeon’s dx

A

Incisional Deep SSI

49
Q

This is an infection that involves any part of the anatomy that was manipulated and at least one of the following:

a. Purulent drainage from the organ or space
b. Positive culture
c. Visual, reoperative, radiological or histopathological evidence of organ/space infection
d. Surgeon’s dx

A

Organ/Space SSI

50
Q

Degrees of Contamination:

A
  • Clean
  • Clean - contaminated
  • Contaminated
  • Dirty
51
Q

Why is it important to know the degree of contamination?

A
  • Estimate the risk of SSI
  • Identify potential pathogens
  • Establish the need of prophylasctic abx
  • Decide type of closure and post-op care

***Poor predictors of overall risk for SSI!!!!!!

52
Q

Describe a clean or class I type of wound.

A
  • Surgical procedure with prepped skin
  • Not infected
  • No pre-existing skin inflammation
  • No resp, GI or GU tract involvement
  • Primary Closure
53
Q

Example of Clean Wound?

A
  • Hernia
  • Thyroidectomy
  • Vagotomy
  • Neurosurgery
54
Q

Describe a clean-contaminated or class II type of Wound.

A
  • Respiratory, GI, or GU tract
  • Mechanical and antibacterial preparation
  • No evidence of an active infection
  • Minor sterile technique errors
55
Q

Example of Clean-Contaminated Wound?

A
  • Cholecystectomy
  • Appendectomy
  • Colonic Resection
  • Adenoidectomy
56
Q

Describe a contaminated or class III type of wound.

A
  • Acute non-purulent inflammation
  • Traumatic open wound
  • Major failure in sterile technique (emergent open massage)
  • Significant GI leak (Colonia, biliary..etc)
  • Secondary or delayed primary closure
57
Q

Example of Contaminated Wound?

A
  • Gangrenous Cholecystitis

- Enterotomy

58
Q

Describe a dirty or class IV type of Wound.

A
  • Old traumatic would (>6 hrs)
  • Necrotic or infected wound
  • Hollow organ perforation
  • Active infection
  • Delayed closure
59
Q

Example of Dirty Wound?

A
  • Perforated Appendicular Abscess
  • Perforated Diverticulitis
  • Infected Mesh
60
Q

Risk of infection for a clean wound? Common agent?

A

1-3%; S. aureus/epidermidis

61
Q

Risk of infection for a clean-contaminated wound? Common agent?

A

2.4-7.7%; Endogenous flora

62
Q

Risk of infection for a contaminated wound? Common agent?

A

6.4-15.2%; Endogenous flora

63
Q

Risk of infection for a dirty wound? Common agent?

A

7.1-40%; Mixed agents

64
Q

What is acute care management for a surgical infection?

A
  • Resuscitate
  • Open Wound
  • Obtain cultures from deeper wounds
  • Abx Therapy
65
Q

What is long-term care management for a surgical infection?

A
  • Improve patient condition (DM, immune status)
  • Standard versus moist therapy
  • Wound VAC (vacuum assisted closure)
66
Q

Classifying a wound by color! What would yellow indicate?

A

Dirty

67
Q

Classifying a wound by color! What would green indicate?

A

Infected

68
Q

Classifying a wound by color! What would pink indicate?

A

Epithelialized

69
Q

Classifying a wound by color! What would black indicate?

A

Necrotic

70
Q

Classifying a wound by color! What would red indicate?

A

Granulated

71
Q

What is the regular therapy for a wound?

A
  • Saline
  • Gauzes/Pads
  • Soap, iodine, vaseline
  • Frequent changes (q 4-6 hours)
  • Tape
72
Q

Side Effects of Regular Therapy:

A
  • Contact Dermatitis

- Skin Damage

73
Q

Moisture Therapy!

A
  1. Moisture Keepers (Opsite/Tegaderm; Hydrocolloids, hydropolymers hydraocellular)
  2. Debridement agents (hydrogels; calcium/collagen alginates; Activated charcoal/silver alginates; collagenase)
74
Q

Side Effects of Moist Therapy:

A
  • Bleeding
  • Hypergranulation
  • Skin maceration
  • Allergic Reactions

Surgery (12 decks)

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