surgical site infections Flashcards
what is and SSI?
infections occurring in an incision made by a surgical procedure
- SSI’s are responsible for what percentage of HCAI?
- 20%
what is the differance between primary and secondary wound closure ?
PRIMARY
- heels from top to bottom due to sutures, this creates a gap at the bottom where fluid can collect and cause infection.
-scalpel made, deep and narrow
SECONDARY
- broader based wound, with granulation tissue
- granulates from the base and heels from the bottom to top
- scar more apparent
what are different signs of infection?
- inflammation
- discharge
- collection of puss
- pain
- systemic symptoms, sepsis
what are the 5 signs of inflammation?
- redness
- heat
- swelling
- pain
- loss of function
what are examples of mild to severe presentation of SSI?
- wound discharge
- dehiscence
- adbscesses
- necrosis
- gangrene
- sepsis
what are patient factors for risk of SSI?
- age
- nutrional state/diet
- diebetes
- immunosupressed
- smoker
what are operation factors for risk of SSI?
- poor closure of wound
- legnth of procedure
- foreign material in surgical site
- shaving
- insertion of surgical drain
how and why do surgical site infections occur?
- contamination of incision by normal microbiota
- damage to tissue
- damage to blood vessels
- foreign bodies
- reduced inflmmatory response
when can surgical site infections occur
before, during and after surgery
example of skin bacteria that causes SSI
staph aureus
example of bowel bacteria that causes SSI
e. coli
what are 3 conseqeunces of SSI?
- microbial penetration of deeper tissue
- infection spread to bloodstream
- spread of bacteria to other site
what are the 3 groups of factors that influence the development of SSI?
- pre operative
- intraoperative
- post operative
what are preoperative factors that influence the development of SSI
- MRSA (has to be screened for)
- pre op shower (clean as possible)
- do not remeve hair
- give antibiotic prophylaxis before.
3 main things and how for disinfection
1- hands of hosp staff (wash with non-antimicrobial soap or alcohol based hand rub)
2- hands of surgical team ( scrub with antiseptic surgical solution)
3- patients skin (iodine or alcoholic chlorhexidine)
what is the responsibility of the surgical team in the operation theatre?
- skill of individual surgeon
- quality of aseptic technique
- wear gloves
- follow protocl
- protective clothing
what are intraoperative factors that infleunce SSI?
- decontamination of hands
- sterile field
- sterile gown and gloves
- debridment of death and necrotic tissue
- wound closure
- cover insision with appropriate dressing
- establish a good blood supply
what is the purpose of the laminar flow?
all air flows down the way into vents at the bottom of the room and the air will never be recirculated
what are risk factors for prosthetic joint infections?
- rheumatoid arthritis
- diabeties mellitus
- malnutrition
- obesity
clean class I surgical wound
- elective surgery
- no acute inflmmation
- does not nvolve respiratory, GI or GU
clean/contaminated II surgical wound
- urgent/ emergency case
- clean wound with a higher risk of infection
- uncomplicated respiratory, GI or GU
contaminated III surgical wound
- outside object comes into contact with wound
- large amounts of spillage from GI into wound
dirty IV surgical wound
- purulent inflammation
- foreign object lodged in wound
- trauma or infected
what are the different microbial loads of the 4 different types of surgical wound?
clean = <10 cfu/ml
clean/contaminated = 20-40 cfu/ml
contaimated = 1000-1500 cfu/ml
dirty = >3500 cfu/ml
what happens to the incidence of SSI with or without antibiotic prophylaxis
the incidence will decrease with antibiotic prophylaxis
what are post op factors that will infleunce SSI
- use appropraite dressing
- use aseptic or non touch tenchniques to chnage or remove dressing
- use sterile saline for 48 hrs
- keep post op stay in hosp to a minimum
3 types of conventional dressing
- gauze
- non adhesive farics
- tulle gras
2 types of occlusive dressing
- hydrocolloids
- foams
- polyurethane films
when will vacum dressings be used
- wound heeling by secondary intention
- wounds with high amount of exudate
