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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
Q

Microbial causes of SSI’s in bowel

A

Escherichia coli
Bacteroides fragilis
Clostridium perfringens
Enterococci spp
Anaerobic cocci

26
Q

Symptoms of SSI’s

A

Wound discharge
Purulent discharge
Gas gangrene
Early signs of fat necrosis
Wound dehiscence

27
Q

What is wound dehiscence ?

A

A surgery complication where the incision, a cut made during a surgical procedure, reopens.

28
Q

Consequences of SSIs

A
  • 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
Q

Factors influencing development of SSI’s

A

Pre - operative
Intra - operative
Post - operative

30
Q

Name 4 preoperative factors to decrease risk of SSI’s

A

MRSA screening

Preoperative showering

Don’t remove hair until immediately pre-operatively (clippers)

Give antibiotic prophylaxis

31
Q

MRSA

A

Methicillin Resistant Staphylococcus Aureus

32
Q

When should you give antibiotic prophylaxis to decrease the risk of SSI’s ?

A

Before :

  • Clean surgery (prosthesis or implant only)
  • Clean-contaminated surgery
  • Contaminated surgery
33
Q

What should be disinfected to prevent SSI’s ?

A

Hands of hospital staff
Hands of surgical team
Patient’s skin

34
Q

Describe disinfection of hands of hospital staff

A

Wash with non-antimicrobial soap and water
Alcohol based hand rub should be used

35
Q

Describe disinfection of hands of surgical team

A

Scrub with aqueous antiseptic surgical solution before first & subsequent operation.

If not visibly soiled, subsequently use AB Skin prep
(Chlorhexidine, Betadine)

36
Q

Describe disinfection of patient’s skin

A

Alcoholic chlorhexidine (preferred)

Povidone iodine (potency can be reduced in ‘bloody’ wounds)

37
Q

Name some intraoperative factors to decrease the risk of SSI’s

A

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
Q

Debridement

A

Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.

39
Q

Role of the surgical team

A
  • Skill of individual surgeon
  • Quality of aseptic technique
  • Careful tissue handling
  • Adequacy of protective clothing
  • Wearing of gloves
  • Theatre design
  • Local protocol
40
Q

What creates an ultraclean zone around the operative site ?

A

Laminar flow

41
Q

Name the classes of surgical wounds

A

Class :

  1. Clean
  2. Clean/contaminated
  3. Contaminated
  4. Dirty
42
Q

Clean (Class 1)

A

Elective surgery
No acute inflammation
Doesn’t involve respiratory, GI or GU tracts

43
Q

Clean/Contaminated (Class 2)

A

Urgent/emergency case
Clean wound with a higher risk of infection
Uncomplicated respiratory, GI or GU tract surgery

44
Q

Contaminated (Class 3)

A

Outside object comes into contact with wound
Large amounts of spillage from GI tract into wound

45
Q

Dirty (Class 4)

A

Purulent inflammation
Foreign object lodged in wound
Traumatic or infected wounds

46
Q

Microbial load at time of surgery
For Class 1-4

A
  1. <10 cfu/ml
  2. 20-40 cfu/ml
  3. 1000-1500 cfu/ml
  4. > 3500 cfu/ml
47
Q

Incidence of SSIs without antibiotic prophylaxis

A
  1. 2%
  2. 6-9%
  3. 13-20%
  4. 40%
48
Q

Incidence of SSIs with antibiotic prophylaxis

A
  1. 2%
  2. 3-4%
  3. 6-7%
  4. 7-16%
49
Q

Types of wound closure methods

A
  • Interrupted suture
  • Interrupted Mattress sutures
  • Staples
  • Continuous/ subcuticular suture
50
Q

Name some postoperative factors to decrease the risk of SSI’s

A

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
Q

Conventional dressings

A

Gauze
Tulle gras
Non-adhesive fabrics

52
Q

Occlusive dressings

A

Hydrocollids
Polyurethane films
Foams

53
Q

Vacuum dressings

A

Wound healing by second intention
Wounds with high amounts of exudate

54
Q

Device associated infections

A

ANY INDWELLING DEVICE

Vascular access devices (cannula to central line)

Endotracheal tubes

Urinary catheter

55
Q

Risk factors for prosthetic joint infections

A

Rheumatoid arthritis
Diabetes mellitus
Malnutrition
Obesity
Anaemia
Immunosuppression

56
Q

Prosthetic joint infection diagnostics

A

History and examination
Blood culture
Culture bone biopsy
Raised inflammatory markers
Radiological imaging
Joint aspiration for culture and microscopy

57
Q

What is classed as a SSI ?

A

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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