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Infectious Disease > Surgical Site Infections > Flashcards

Surgical Site Infections Flashcards

1
Q

Wound classification: Clean

A

An uninfected operative wound in which no inflammation is encountered and respiratory, alimentary, genital or uninfected urinary tracts are not entered.

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2
Q

Wound classification: Clean Abx

A

Not indicated unless high-risk procedure

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3
Q

Wound classification: Clean-contaminated

A

Operative wounds in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.

Specifically operations involving the biliary tract, appendix, vagina and oropharynx.

Provided no evidence of infection or major break in technique is encountered.

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4
Q

Wound classification: Clean-contaminated Abx use

A

Prophylactic antibiotics indicated

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5
Q

Wound classification: Contaminated

A

Open, fresh, accidental wounds.

Operations with major breaks in sterile technique or gross spillage from GI tract and incisions in which acute, nonpurulent inflammation is encountered.

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6
Q

Wound classification: Contaminated Abx use

A

Prophylactic antibiotics indicated

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7
Q

Wound classification: Dirty

A

Old traumatic wounds with retained devitalized tissue and those that involve clinical infection or perforated viscera.

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8
Q

Wound classification: Dirty Abx use

A

Therapeutic antibiotics indicated

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9
Q

JS a 65 y/o male underwent a radical prostatectomy requiring entry into GU tract .

No prior infection noted and no major breaks in sterile technique noted.

How would you classify the wound?
A.) Clean
B.) Clean-contaminated
C.) Contaminated
D.) Dirty
E.) Dirty-contaminated
A

B.) Clean-contaminated

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10
Q

Surgical site infection Microbiology most common pathogens?

A

Staphylococcus aureus 23%

Coagulase-negative staphylococci 17%

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11
Q

Which of the following pairs represents the most common pathogens in surgical site infections?

A.) Staphylococcus aureus and Coagulase-negative staphylococci
B.) Staphylococcus aureus and Acinetobacter spp.
C.) Serratia spp. and Proteus spp.
D.) Enterococcus and Pseudomonas spp.
E.) Streptococci and Klebsiella spp.

A

A.) Staphylococcus aureus and Coagulase-negative staphylococci

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12
Q

Factors affecting SSI

A 
SSI
	Procedure related
	Operating Room related
	Antibiotic prophylaxis 
	Patient related
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13
Q

Patient-related factors

A 
Age
Glucose control
Obesity
Smoking
Immunosuppression 
Nutrition status
Remote site(s) of infection/Previous hospitalization
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14
Q

Procedure-related factors

A

Hair removal

Skin preparation
Patient
Surgeon
Incision

Surgeon skill/technique

Oxygenation

Normothermia

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15
Q

Operating Room related factors

A

Ventilation

Traffic

Environmental surfaces

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16
Q

Surgical site prevention strategies pre-hospital

A

Preoperative bathing

Smoking cessation

Glucose control

MRSA screening

Bowel preparations

17
Q

Surgical site prevention strategies hospital

A

Glucose control

Hair removal

Skin preparation

Surgical hand scrub

Surgical attire

Intraoperative normothermia

Wound protectors

Antibiotic sutures

Gloves/instruments

Wound closure

Topical antibiotics

Supplemental oxygen

Wound care

18
Q

Which of the following statements is FALSE regarding factors associated with SSIs?

A.) Impaired glucose control increases risk of SSI
B.) Smoking augments the chance of acquiring a SSI
C.) Poor ventilation may result in contamination of wounds and SSIs
D.) Low OR traffic is associated with higher rates of SSIs
E.) Maintaining normothermia reduces SSIs

A

D.) Low OR traffic is associated with higher rates of SSIs

High operating room traffic is associated with higher rates of SSI’s

19
Q

Principles of surgical prophylaxis

A

Antimicrobial agent(s) should:

  1. Prevent SSI
  2. Prevent SSI-related morbidity and mortality
  3. Reduce the duration and cost of health care
  4. Produce no adverse effects
  5. Have no adverse consequences for the microbial flora of the patient or hospital
20
Q

When is cefazolin inappropriate?

A

Additional anaerobic coverage
-Colorectal surgery

Additional Gram-negative coverage

MRSA colonization

Severe beta-lactam allergy

21
Q

Procedures requiring anaerobic coverage

A

Appendectomy for uncomplicated appendicitis

Small intestine with obstruction

Colorectal

Urologic - Clean-contaminated

Head and neck - Clean-contaminated

22
Q

MRSA colonization

A

Considered for patients with known or high risk
High risk: recent hospitalization, nursing-home residents, hemodialysis patients

Screening and decolonization
Total joint replacement
Cardiac procedures

Decolonization should be completed close to date of surgery

Vancomycin should NOT be administered to MRSA-negative patient

23
Q

Prophylaxis dosing weight

A 
Ampicillin/sulbactam - 3g
Aztreonam - 2g
****Cefazolin - 2g, 3g (≥120kg)****
Cefuroxime - 1.5g
Cefotaxime - 1g
Cefoxitin - 2g
Ceftriaxone - 2g
Ciprofloxacin - 400mg
Clindamycin - 900mg
Ertapenem - 1g
****Gentamicin - 5mg/kg (single dose)****
Levofloxacin  - 500mg
Metronidazole - 500mg
****Vancomycin - 15mg/kg****
24
Q

Timing of initial dose

A

Deliver antibiotic to operative site prior to contamination
-Achieve sufficient tissue concentrations

One hour before incision
-2 hours for vancomycin and fluoroquinolones

If given after incision no appreciable effect on SSIs

25
Q

Intraoperative redosing for prevention of surgical site infections

A

Redose if procedure exceeds two half-lives of antimicrobial

OR

Estimated blood loss of >1500 ml

26
Q

Intraoperative redosing Ampicillin/sulbactam

A

2 hrs

27
Q

Intraoperative redosing Aztreonam

A

4 hrs

28
Q

Intraoperative redosing Cefazolin

A

4 hrs

29
Q

Intraoperative redosing Cefuroxime

A

4 hrs

30
Q

Intraoperative redosing Cefotaxime

A

3 hrs

31
Q

Intraoperative redosing Cefoxitin

A

2 hrs

32
Q

Intraoperative redosing Clindamycin

A

6 hrs

33
Q

Duration of prophylaxis according to ASHP/SIS/SHEA

A

Should be less than 24 hours for most procedures

34
Q

Duration of prophylaxis according to WHO

A

Surgical antibiotic prophylaxis administration should not be prolonged after completion of the operation

35
Q

TJ is a 73 y/o female who will undergo elective colorectal surgery today at 1700. No active infection. TJ weighs 115 kg.

Allergies: NKDA

PMH: HTN

What prophylaxis would you recommend?

A.) Cefazolin 3 g 
B.) Cefazolin 2 g
C.) Clindamycin 900 mg + gentamicin 5 mg/kg
D.) Cefazolin 3 g + metronidazole 500 mg
E.) Cefazolin 2 g + metronidazole 500 mg
A

E.) Cefazolin 2 g + metronidazole 500 mg

36
Q

TJ is a 73 y/o female who will undergo elective colorectal surgery today at 1700. No active infection. TJ weighs 115 kg.

Allergies: NKDA

PMH: HTN

At what interval would you recommend redosing the cefazolin?

A.) 2 hours
B.) 4 hours
C.) 6 hours
D.) 8 hours
E.) No redosing necessary regardless of procedure duration
A

B.) 4 hours

37
Q

TJ is a 73 y/o female who will undergo elective colorectal surgery today at 1700. No active infection. TJ weighs 115 kg.

Allergies: NKDA

PMH: HTN

What duration would you recommend (including intraoperative dosing)?

A.) One time pre-operative dose
B.) 24 hours
C.) 36 hours
D.) 2 days 
E.) 4 days
A

A.) One time pre-operative dose

Infectious Disease (56 decks)

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