Surgical Infections

Question 1

Define surgical site infection

Answer 1

Infection that develops at the operative site within 30 days of surgery

Question 2

Give 4 signs of surgical infection

Answer 2

• Pain/tenderness
• Localised swelling, redness and heat
• Discharge and drainage
• +/- Systemic infection

Question 3

How much bacteria needs to be in a tissue to cause surgical infection?

Answer 3

> 10(pow)6 bacteria/gram of tissue

Question 4

What are the effects of surgical infection?

Answer 4

Patient suffering
Delayed healing
Wound breakdown

Question 5

Give the 4 surgical factors in likelihood of wound contamination

Answer 5

Asepsis of technique
Orthopaedic vs soft tissue
Duration
Foreign material

Question 6

Describe the perioperative factors in likelihood of wound contamination

Answer 6

Length of anaesthesia
Drugs used (halothane and propofol increase risk)
Wound ischaemia
Hospitalisation

Question 7

What is biofilm?

Answer 7

Structured community of cells enclosed in self produced polymeric matrix adherent to living or inert structures

Question 8

Describe Halsteads 6 principles

Answer 8

1. Gentle tissue handling
2. Strict asepsis
3. Haemostasis (preservation of blood flow)
4. No tension on tissues
5. Good approximation of tissues (aim to bring tissues together for stitching
6. Obliteration of dead space

Question 9

What three factors inform decision making with post op antibiotics?

Answer 9

• Infection/ likelihood of infection
• Potential consequences of infection
• Which bacteria are likely to be present (skin, oral cavity and GIT more bacteria heavy)

Question 10

Describe the kind of antibiotic that you would use for post op

Answer 10

• Cidal not static
• Broad spectrum if given prophylactically
• Culture and sensitivity if therapeutic

Question 11

Describe the process of monitoring a surgical wound

Answer 11

• Check after 24 hours and change dressing
• Change dressing as soon as evidence of strike through
• Provide elizabethan collar to use if necessary
• Provide clear post op instructions

Question 12

Describe the signs of and actions taken for an orthopaedic infection

Answer 12

Initial sign –> soft tissue aspirate (Cult+Sens)
Radiographic changes
Remove any unnecessary implants

Question 13

Give the 4 types of wound classification

Answer 13

Clean
Clean Contaminated
Contaminated
Dirty

Question 14

Describe the type of surgical wound that would be classified as clean

Answer 14

Elective non traumatic procedure
No break in asepsis
No entry to respiratory tract/ Gi tract / urinary system

Question 15

Describe the type of surgical wound that would be classified as clean contaminated

Answer 15

Minor break in asepsis
Entry into GI/ urinary/ respiratory tract
Antibiotics administerd
2.5-9.5% infection rate

Question 16

Describe the type of surgical wound that would be classified as contaminated

Answer 16

Traumatic wound <4 hours old
Break in aseptic technique
Spillage from viscera
Admin antibiotics
5.5-25% infection rate

Question 17

Describe the type of surgical wound that would be classified as dirty

Answer 17

Traumatic wound >4 hours old
Perforated viscera
Bacteria infection, abcess/pus
Admin antibiotics