Surgical Site Infections Flashcards
What are SSIs?
1- Surgical site infections 2- Occur in wounds treated by invasive surgical procedures 3- Responsible for ~20% of HCAIs 4- Can double length of hospital stay 5- Associated with high morbidity
What percentage of patients undergoing surgery develop an SSi?
5%
What are the eight types/examples of SSIs?
1- Wound discharge 2- Dehiscence 3- Lymphadenitis 4- Formation of abscesses 5- Necrosis 6- Gangrene 7- Spread to deeper tisue 8- Sepsis
What are the possible consequences of SSIs?
1- Microbial penetration into deeper tissue
2- Invasion of bloodstream leading to bacteraemia and sepsis
3- Spread of bacteria to other sites like the heart valves, bones or peritoneum
How, when and why can SSIs occur?
1- Contamination of incision by normal microbiota
2- Damage to tissues
3- Damage to blood vessels
4- Presence of foreign bodies such as sutures or implants
5- Reduced efficacy of inflammatory response
6- May occur before, during or after surgery
What factors influence the development of SSIs?
1- Type of surgical wound 2- If wound is clean or dirty 3- Preoperative, intraoperative and postoperative care 4- Surgical team 5- Age and general health 6- Extent of tissue injury 7- Infection prevention procedures 8- Presence of prosthesis or foreign body 9- Presence or absence of drain 10- Duration of surgery 11- Place in operation list
What are the four classes of surgical wounds?
1- Class I: clean
2- Class II: clean/contaminated
3- Class III: contaminated
4- Class IV: dirty
Describe a class of I wound
1- Clean
2- Elective surgery
3- No acute inflammation
4- Does not involve respiratory, gastrointestinal or genitourinary tracts
Describe a class II wound
1- Clean/contaminated
2- Urgent or emergency case surgery
3- Clean wounds with higher risk of infection
4- Uncomplicated R, GI or GI tract surgery
Describe a class III wound
1- Contaminated
2- Outside objects may have come into contact with wound
3- Large amounts of spillage from GI tract into wound
Describe a class IV wound.
1- Purulent (pus filled) inflammation
2- Foreign object may be lodged in wound
3- Traumatic or infected wound
What is antibiotic prophylaxis?
Antibiotics given before surgery
What is the microbial load of class I wounds at time of surgery?
Less than 10 cfu/ml
What is the microbial load of class II wounds at time of surgery?
20-40 cfu/ml
What is the microbial load of class III wounds at time of surgery?
1000-1500 cfu/ml
What is the microbial load of class IV at time of surgery?
More than 3500 cfu/ml
What are the most common microbial causes of SSIs?
1- Staphylococcus aureus 2- Streptococci spp. 3- Enterococci spp. 4- Echerichia coli 5- Bacteroides fragilis 6- Clostridium perfringes 7- Eterococci sp. 8- Anaerobic cocci
What does preoperative care include?
1- Preopeative showering
2- Hair should not be removed but clipped
3- Give antibiotic prophylaxis before class I, II and II surgery
4- Nasal decontamination should not be routinely done
5- Mechanical bowel preparation should not be routinely done
What does intraoperative care include?
1- Surgical team should decontaminate hands
2- Non-iodophor-impregnates incise drapes should NOT be used
3- Sterile gown and two pairs of sterile gloves
4- Skin at incision site should be prepared immediately before incision
5- Homeostasis maintained
6- Wound irrigation or intracavity lavage should not be used
7- Inntraoperative disinfection and topical antibiotics should not be used
8- Incisions should be covered with appropriate dressing at the end
How should the hands of ward staff be disinfected?
1- Washed with non-antimicrobial soap and water
2- ABHR should be used
How should the hands of the surgical team be disinfected?
- Scrubbed with aqueous antiseptic surgical solution before first operation
2- If hands are not visibly soiled, ABHB or antiseptic surgical solution should be used
How should the patient’s skin be disinfected?
Alcoholic chlohexidine
Providone iodine
What are the two types of dressings?
1- Conventional
2- Occlusive
What are three examples of conventional dressings?
Gauze
Tulle gras
Non-adhesive fabrics
