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Medicine Year 1 Semester 1 - Part 2 > Surgical Site Infections > Flashcards

Surgical Site Infections Flashcards

1
Q

What is a surgical site infection ?

A

Infections occurring in an incision made by an invasive surgical procedure.

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2
Q

What % of HAI’s do surgical site infections account for ?

A

Roughly 20%

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3
Q

Facts about SSI’s

A
  • Incidence varies depending on how ‘clean’ the surgery is
  • Increase length of hospital stay
  • Associated with high morbidity
  • Prevention is better than a cure
  • Since 2005 “Surgical Site Infections” (x3) cited >650 times
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4
Q

Louis Pasteur

A

Germ theory of disease

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5
Q

Joseph Lister

A

Father of modern surgery.

He found a way to prevent infection in wounds during and after surgery.

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6
Q

Sir Alexander Ogston

A

First known germaphobe :)

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7
Q

Wound healing by primary intention

A

Clean narrow incision
Inflammation and proliferation
Minimal scarring
Remodelling

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8
Q

Wound healing by secondary intention

A

Broader based wound
Granulates over and heals from the base
Wider more visible scar

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9
Q

Name some signs of infection

A
  • Inflammation
  • Erythema
  • Discharge
  • Fluctuant Collection
  • Failure to heal
  • Pain
  • Systemic symptoms of sepsis
  • Pyrexia
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10
Q

Bacteremia

A

Simple presence of bacteria in the blood.

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11
Q

Septicemia

A

The presence and multiplication of bacteria in the blood.

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12
Q

Differences between bacteremia and septicemia

A

Bacteremia - less amounts of bacteria in blood

Septicemia - toxins may be produced by bacteria
- potentially life-threatening

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13
Q

5 symptoms of inflammation

A

Rubor- redness
Calor - heat
Tumor - swelling
Dolor - pain
Loss of function

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14
Q

Rubor

A

Erythema/redness

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15
Q

Calor

A

Increased temperature

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16
Q

Tumor

A

Swelling

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17
Q

Dolor

A

Pain

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18
Q

Risk factors of SSI’s

A

Patient factors
Operation factors

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19
Q

Patient factors increasing chances of SSI’s

A

Extremes of age
Poor nutritional state
Diabetes mellitus
Renal failure
Immunosuppression
Current smoker
?Ethnicity

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20
Q

Operation factors increasing chances of SSI’s

A

Preoperative shaving or site of incision
Length of operation
Tissue handling
Foreign material in surgical site
Insertion of surgical drain
Poor closure of wound

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21
Q

How do surgical site infections occur ?

A

Contamination of incision by normal microbiota

Damage to tissues

Damage to blood vessels - reduced blood supply, reduced immune response

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22
Q

Why do surgical site infections occur ?

A

Presence of foreign bodies
(e.g. sutures, implants)

Reduced efficacy of inflammatory response

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23
Q

When do surgical site infections occur ?

A

Contamination can occur before, during and after surgery.

24
Q

Microbial causes of SSI’s on skin

A

Staphylococcus aureus
Streptococci spp
Enterococci spp

25
Microbial causes of SSI's in bowel
Escherichia coli Bacteroides fragilis Clostridium perfringens Enterococci spp Anaerobic cocci
26
Symptoms of SSI's
Wound discharge Purulent discharge Gas gangrene Early signs of fat necrosis Wound dehiscence
27
What is wound dehiscence ?
A surgery complication where the incision, a cut made during a surgical procedure, reopens.
28
Consequences of SSIs
* Microbial penetration of deeper tissues * Infection spread to bloodstream (bacteraemia, sepsis) * Spread of bacteria to other sites (e.g. heart valves, bones, joints, peritoneum, CNS)
29
Factors influencing development of SSI's
Pre - operative Intra - operative Post - operative
30
Name 4 preoperative factors to decrease risk of SSI's
MRSA screening Preoperative showering Don't remove hair until immediately pre-operatively (clippers) Give antibiotic prophylaxis
31
MRSA
Methicillin Resistant Staphylococcus Aureus
32
When should you give antibiotic prophylaxis to decrease the risk of SSI's ?
Before : - Clean surgery (prosthesis or implant only) - Clean-contaminated surgery - Contaminated surgery
33
What should be disinfected to prevent SSI's ?
Hands of hospital staff Hands of surgical team Patient's skin
34
Describe disinfection of hands of hospital staff
Wash with non-antimicrobial soap and water Alcohol based hand rub should be used
35
Describe disinfection of hands of surgical team
Scrub with aqueous antiseptic surgical solution before first & subsequent operation. If not visibly soiled, subsequently use AB Skin prep (Chlorhexidine, Betadine)
36
Describe disinfection of patient's skin
Alcoholic chlorhexidine (preferred) Povidone iodine (potency can be reduced in ‘bloody’ wounds)
37
Name some intraoperative factors to decrease the risk of SSI's
Sterile field + gown + gloves with good scrubbing technique Prepare skin immediately before incision Debridement of dead and necrotic skin Establish a good blood supply Maintain patient homeostasis Intraoperative disinfection or topical antibiotics Wound closure Cover incisions with appropriate dressings at the end -ve pressure dressings in higher risk cases
38
Debridement
Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.
39
Role of the surgical team
* Skill of individual surgeon * Quality of aseptic technique * Careful tissue handling * Adequacy of protective clothing * Wearing of gloves * Theatre design * Local protocol
40
What creates an ultraclean zone around the operative site ?
Laminar flow
41
Name the classes of surgical wounds
Class : 1. Clean 2. Clean/contaminated 3. Contaminated 4. Dirty
42
Clean (Class 1)
Elective surgery No acute inflammation Doesn't involve respiratory, GI or GU tracts
43
Clean/Contaminated (Class 2)
Urgent/emergency case Clean wound with a higher risk of infection Uncomplicated respiratory, GI or GU tract surgery
44
Contaminated (Class 3)
Outside object comes into contact with wound Large amounts of spillage from GI tract into wound
45
Dirty (Class 4)
Purulent inflammation Foreign object lodged in wound Traumatic or infected wounds
46
Microbial load at time of surgery For Class 1-4
1. <10 cfu/ml 2. 20-40 cfu/ml 3. 1000-1500 cfu/ml 4. >3500 cfu/ml
47
Incidence of SSIs without antibiotic prophylaxis
1. 2% 2. 6-9% 3. 13-20% 4. 40%
48
Incidence of SSIs with antibiotic prophylaxis
1. 2% 2. 3-4% 3. 6-7% 4. 7-16%
49
Types of wound closure methods
* Interrupted suture * Interrupted Mattress sutures * Staples * Continuous/ subcuticular suture
50
Name some postoperative factors to decrease the risk of SSI's
Use appropriate dressings Use aseptic or non-touch technique to change or remove dressings Minimise dressing changes Use sterile saline for wound cleansing up to 48hs after surgery Keep preoperative length of stay in hospital to a minimum Treat any (con)current infections before surgery Prevent pressure sores by good nursing care Enhanced Recovery After Surgery (ERAS)
51
Conventional dressings
Gauze Tulle gras Non-adhesive fabrics
52
Occlusive dressings
Hydrocollids Polyurethane films Foams
53
Vacuum dressings
Wound healing by second intention Wounds with high amounts of exudate
54
Device associated infections
ANY INDWELLING DEVICE Vascular access devices (cannula to central line) Endotracheal tubes Urinary catheter
55
Risk factors for prosthetic joint infections
Rheumatoid arthritis Diabetes mellitus Malnutrition Obesity Anaemia Immunosuppression
56
Prosthetic joint infection diagnostics
History and examination Blood culture Culture bone biopsy Raised inflammatory markers Radiological imaging Joint aspiration for culture and microscopy
57
What is classed as a SSI ?
Within 30 days of surgery, or within a year if a prsoethic device is left in.

Medicine Year 1 Semester 1 - Part 2 (37 decks)

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