T1 Lecture 1: Would Classification, Wound Infection, Antimicrobial use Flashcards
What are 4 ways to classify Operative
Wounds?
1• Clean
2• Clean-contaminated
3• Contaminated
4• Dirty
Describe what a clean wound is?
Surgically created
wound
-No infection
encountered
-Aseptic technique
maintained
-No structure normally
containing bacteria opened
Describe what a clean contaminated wound is?
Surgically created
wound but…
-Hollow viscus or organ normally containing bacteria is opened but no contents are spilled
-Minor break in technique occurs like a hole in glove
detected
Describe what a contaminated wound is?
Surgical wound but…
- Hollow viscus is opened with gross spillage
- Major break in technique
- Example: Traumatic wound
A traumatic wound is an example of a _____ wound
Contaminated
Describe a dirty wound?
Contain pus or Contain contents of perforated hollow viscus
What is the goal of aseptic technique?
The goal of aseptic technique is to minimize the incidence of surgical wound infection
The risk of infection ____ with every ___-___minutes of surgery (anesthesia)…
doubles; 70-90
Rule of thumb risk doubles every ___
hour
____ is trauma
Time
Describe some general details about infection and distinguish it from infection/inflammation?
Infection: Presence of purulent drainage, Abscess, Fistula
Infection/Inflammation:
-Infection OR:
Greater than 3 of the following signs at the same time:
- Redness
- Swelling
- Pain
- Heat
- Serous discharge
- Wound dehiscence
What are the Three major risk factors of infection?
- Duration of sx
- Increasing number of persons in operating
room - Dirty surgical site
What is an example of a protective factor for infection?
Antibiotic prophylaxis
Infection/Inflammation is associated with these 6 significant factors?
Double D’s will increase dirty assholes
Double D’s will increase dirty assholes
(when you have huge boobs youll have increased prevalence of asshole men!)
- Duration of anesthesia
- Duration of post-op ICU stay
- Wound drainage
- Increased patient weight
- Dirty surgical site
- Antimicrobial prophylaxis
_____ has the highest incidence of sx infections @ 5.8-28.6% and ____ actually implies an infection is present
Contaminated; dirty
What are 3 considerations with contamination and time leading to an infection?
1) # and virulence of bacteria
2) Competence of host
defenses
3) Amount of tissue damage
and dead space from procedure
What is the most common source of operative wound infections?
The patient’s endogenous flora
Most common source (Skin 1st) and the GI tract
What are the 4 main sources of operative wound infections?
- The operating room environment
- The operating team
- Surgical instruments and supplies
- The patients endogenous flora
What is surprising to learn about implementing the role of aseptic technique? Also answer why we continue to practice aseptic technique?
Despite precautious hospital protocol and standard operating procedures there is surprisingly little evidence and few controlled studies to support it makes a huge difference in reducing infections
We still do it because its standard of care and it applies to how you are judged when something goes wrong?
Describe what a surgical site infection is?
Infection at surgical site occurring within 30 days of surgery or up to 1 year with implants often happening with superficial wounds that travel deep
The use of antibiotics should be based on sound principles and established benefit, they are often overused and misused and increase the risk of…….?
developing antibiotic resistant strains
True or False:
Antibiotics are a good substitute for good surgical technique?
FALSE
(jenn if you get this wrong imma smack the piss outta you) <3 you
How do we implement the use of prophylactic antibiotic use in surgery? What about therapeutic?
Prophylactic: Administered PRIOR to wound contamination
Therapeutic: infection already present and using to tx it
What are some considerations we think about when deciding whether or not to prescribe prophylactic antibiotics?
- Risk of infection high or infection would have catastrophic results
or
- Patient factors, type and length of surgery, experience of surgeon
Prophylactic antibiotics should be administered _____ to surgery and administered __-___ min ___ to _____ _____
PRIOR; 30-60, prior to skin incision
Are Prophylactic antibiotics continued perioperatively?
Continued perioperatively – but not longer than 24 hours
Intraoperatively, Prophylactic antibiotics should be given every __-__ minutes, name an example
Given q 90-120 minutes
Cefazolin 22mg/kg IV
When do we give therapeutic antibiotics?
- Systemic infection present (septicemia)
- Infection present at surgical site or in body
cavity (wound infection, pyothorax) - Contaminated or dirty procedure
Ideally administration of therapeutic antibiotics is based on culture and sensitivity or
changed with results, when do you start them if you have a scheduled sx and do they continue? If no improvement?
Started before surgery and continued for 2-3 days AFTER resolution of infection
If no improvement in 2-3 days after starting tx Re-evaluate
Postoperative infections are minimized by? (3)
Minimize by good
nursing care practices such as:
- Protect incision lines
- Wash hands between
patients, gloves preferred ya nasty - Remove catheters and
drains in timely fashion
