T1 Lecture 1: Would Classification, Wound Infection, Antimicrobial use

Question 1

What are 4 ways to classify Operative

Wounds?

Answer 1

1• Clean
2• Clean-contaminated
3• Contaminated
4• Dirty

Question 2

Describe what a clean wound is?

Answer 2

Surgically created
wound

-No infection
encountered

-Aseptic technique
maintained

-No structure normally
containing bacteria opened

Question 3

Describe what a clean contaminated wound is?

Answer 3

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

Question 4

Describe what a contaminated wound is?

Answer 4

Surgical wound but…

• Hollow viscus is opened with gross spillage
• Major break in technique
• Example: Traumatic wound

Question 5

A traumatic wound is an example of a _____ wound

Answer 5

Contaminated

Question 6

Describe a dirty wound?

Answer 6

Contain pus or Contain contents of perforated hollow viscus

Question 7

What is the goal of aseptic technique?

Answer 7

The goal of aseptic technique is to minimize the incidence of surgical wound infection

Question 8

The risk of infection ____ with every ___-___minutes of surgery (anesthesia)…

Answer 8

doubles; 70-90

Question 9

Rule of thumb risk doubles every ___

Answer 9

hour

Question 10

____ is trauma

Answer 10

Time

Question 11

Describe some general details about infection and distinguish it from infection/inflammation?

Answer 11

Infection: Presence of purulent drainage, Abscess, Fistula

Infection/Inflammation:

-Infection OR:

Greater than 3 of the following signs at the same time:

1. Redness
2. Swelling
3. Pain
4. Heat
5. Serous discharge
6. Wound dehiscence

Question 12

What are the Three major risk factors of infection?

Answer 12

1. Duration of sx
2. Increasing number of persons in operating
   room
3. Dirty surgical site

Question 13

What is an example of a protective factor for infection?

Answer 13

Antibiotic prophylaxis

Question 14

Infection/Inflammation is associated with these 6 significant factors?

Double D’s will increase dirty assholes

Answer 14

Double D’s will increase dirty assholes

(when you have huge boobs youll have increased prevalence of asshole men!)

1. Duration of anesthesia
2. Duration of post-op ICU stay
3. Wound drainage
4. Increased patient weight
5. Dirty surgical site
6. Antimicrobial prophylaxis

Question 15

_____ has the highest incidence of sx infections @ 5.8-28.6% and ____ actually implies an infection is present

Answer 15

Contaminated; dirty

Question 16

What are 3 considerations with contamination and time leading to an infection?

Answer 16

1) # and virulence of bacteria

2) Competence of host
defenses

3) Amount of tissue damage
and dead space from procedure

Question 17

What is the most common source of operative wound infections?

Answer 17

The patient’s endogenous flora

Most common source (Skin 1st) and the GI tract

Question 18

What are the 4 main sources of operative wound infections?

Answer 18

1. The operating room environment
2. The operating team
3. Surgical instruments and supplies
4. The patients endogenous flora

Question 19

What is surprising to learn about implementing the role of aseptic technique? Also answer why we continue to practice aseptic technique?

Answer 19

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?

Question 20

Describe what a surgical site infection is?

Answer 20

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

Question 21

The use of antibiotics should be based on sound principles and established benefit, they are often overused and misused and increase the risk of…….?

Answer 21

developing antibiotic resistant strains

Question 22

True or False:

Antibiotics are a good substitute for good surgical technique?

Answer 22

FALSE

(jenn if you get this wrong imma smack the piss outta you) <3 you

Question 23

How do we implement the use of prophylactic antibiotic use in surgery? What about therapeutic?

Answer 23

Prophylactic: Administered PRIOR to wound contamination

Therapeutic: infection already present and using to tx it

Question 24

What are some considerations we think about when deciding whether or not to prescribe prophylactic antibiotics?

Answer 24

1. Risk of infection high or infection would have catastrophic results

or

2. Patient factors, type and length of surgery, experience of surgeon

Question 25

Prophylactic antibiotics should be administered _____ to surgery and administered __-___ min ___ to _____ _____

Answer 25

PRIOR; 30-60, prior to skin incision

Question 26

Are Prophylactic antibiotics continued perioperatively?

Answer 26

Continued perioperatively – but not longer than 24 hours

Question 27

Intraoperatively, Prophylactic antibiotics should be given every __-__ minutes, name an example

Answer 27

Given q 90-120 minutes

Cefazolin 22mg/kg IV

Question 28

When do we give therapeutic antibiotics?

Answer 28

1. Systemic infection present (septicemia)
2. Infection present at surgical site or in body
   cavity (wound infection, pyothorax)
3. Contaminated or dirty procedure

Question 29

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?

Answer 29

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

Question 30

Postoperative infections are minimized by? (3)

Answer 30

Minimize by good
nursing care practices such as:

1. Protect incision lines
2. Wash hands between
   patients, gloves preferred ya nasty
3. Remove catheters and
   drains in timely fashion