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ICMS > Therapeutic Agents & the Surgical Patient - Surgical Infection & Antimicrobials > Flashcards

Therapeutic Agents & the Surgical Patient - Surgical Infection & Antimicrobials Flashcards

1
Q

Why is surgical infection a serious issue?

A
  • prolongs healing time
  • failure of procedure
  • dehiscence
  • implant rejection
  • mortality
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2
Q

When does a surgical infection occur?

A

when the microorganisms establish themselves in the tissues & begin to multiple, usually 4-6 hrs after contamination

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3
Q

What are the requirements for infection?

A
  • sufficient dose of pathogenic micro-organisms
  • suitable microbial nutrient medium
  • impairment of natural host defenses
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4
Q

Development of infection is a mixture of…

A
  • nature & degree of microbial contamination
  • the microorganism involved
  • local & systemic host defenses
  • technical factors relating to the Sx
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5
Q

Factors that influence the battle between contaminants & the host’s defenses include:

A
  • microbe-related risk factors
  • host-related risk factors
  • Sx-related risk factors
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6
Q

Surgical infection often results from a microorganism being introduced into the surgical site at

A

the time of surery

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7
Q

What are some endogenous sources of micro-organisms?

A
  • Patient’s flora: GI, resp, urogenital, skin
  • pre-existing infection at another body site via continuation, blood, lymph
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8
Q

What are some exogenous sources of micro-organisms?

A
  • surgical team
  • operating room
  • material that makes contact w/ the wound
  • post-op environment
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9
Q

What are some host-related, systemic risk factors that could led to surgical site infection?

A
  • age
  • weight
  • metabolic status
  • presence of distant infections
  • hypothermia
  • impaired immune response
  • chemotherapeutics/ corticosteroids
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10
Q

What are some host-related local risk factors that can cause a surgical site infection?

A
  • dermatitis at the site
  • propensity to lick & scratch wounds
  • lack of compliance w/ dressings
  • foreign bodies (implants, soil, hair, wood)
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11
Q

What are some surgery-related risk factors that may predispose to surgical site infection?

A
  • patient and surgeon prep
  • surgical technique
  • duration of surgery
  • length of hospitalization
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12
Q

What is the clinical definition of a surgical site infection (SSI)?

A

presence of purulent drainage from the incision site

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13
Q

What are more subtle forms of evaluation of a wound infection?

A
  • general clinical exam
  • wound observation
  • wound palpation
  • labs
  • imaging
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14
Q

What are some general clinical signs of infection that may be found on a general clinical exam?

A

fever, anorexia, lethargy

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15
Q

What signs when observing a wound could indicate a SSI?

A
  • colour, presence, character of discharge
  • deformity or swelling at the site
  • approximation of wound edges
  • appearance of skin at & around wound edges
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16
Q

When palpating a wound, what might indicate a SSI?

A
  • heat, pain, swelling
  • fluid accumulation
  • pitting oedema
  • defects in tissue layers (hernia, dehiscence)
  • abnormal texture
17
Q

What labs might you perform to test for SSI?

A
  • WBC & differentiation, fibrinogen, globulins, etc
  • wound fluids (cytology, culture and sensitivity, biochemistry)
18
Q

What imaging techniques can be used to look for SSI?

A

radiography
ultrasound
scintigraphy
CT scanning
MRI

19
Q

How do you classify the likelihood of wound infection?

A

I - clean
II - clean-contaminated
III - contaminated
IV- dirty &/or infected

20
Q

What wounds are considered clean wounds?

A
  • non traumatic wounds that do not include the resp/oropharyngeal/ GI, or urogenital organs & have no inflammatory processes
  • elective, primarily closed & undrained
  • non-traumatic, uninfected
  • no inflammation encountered
  • no break in aseptic technique
21
Q

What wounds are considered clean-contaminated wounds?

A
  • GI, resp, urogenital tracts under controlled conditions & w/ usual contamination
  • minor breaks in aseptic techniques
  • clean wounds w/ drains
22
Q

What wounds are considered contaminated wounds?

A
  • open, fresh, traumatic wound
  • gross spillage of the GIT
  • entrance into the urogenital or biliary tracts in presence of infected urine or bile
  • incisions in which acute, non-purulent inflammation is encountered
  • major breaks in aseptic techniques
23
Q

What wounds are considered dirty &/or infected?

A
  • traumatic wound w/ retained devitalized tissue & foreign bodies, fecal contamination, or delayed treatment, or from a dirty source
  • perforated viscous
  • acute bacterial inflammation w/ purulent exudates experienced during operation
  • gross infection already present
24
Q

What are some pre-operative ways of improving surgical techniques to prevent SSI’s?

A
  • minimize surgical time w/ pre-op planning
  • delay hair removal until just prior to Sx
  • perform emergency Sx only as necessary
  • Establish good metabolic status & positive nutritional plane
  • minimize length of hospitalization
  • consider pre-op bathing of patient
25
Q

What are some intra-operative ways of improving surgical techniques to help prevent SSI’s?

A
  • prep patient & surgeon’s skin w/ antiseptics
  • use aseptic technique & barriers (surgical caps, masks, gowns, etc)
  • use Sx techniques to minimize tissue trauma, hemorrhage, dead space
  • debride infected or devitalized tissue
  • minimize use of foreign materials
  • use good surgical judgement when closing contaminated or infected wounds
  • tension free tissue apposition
26
Q

What are some post-op methods of improving surgical techniques to help prevent SSI’s?

A
  • minimize length of post-op hospitalization
  • cover or bandage wounds
27
Q

Risk of surgical infection must outweigh the potential adverse side effects to warrant…

A

the use of prophylactic antibiotics

28
Q

prophylactic antibiotics should only be used when…

A

indicated by a likelihood of infection or when occurrence of infection is likely to be catastrophic

29
Q

When would you need prophylactic antibiotics in clean wounds?

A
  • wounds involving an implant or prosthesis
  • situation where development of infection is considered life-threatening
  • high risk patients, animals suffering from concurrent dz processes, underweight or malnourished, geriatric patients, possible those receiving corticosteroids
30
Q

When are prophylactic antibiotics indicated?

A
  • clean-contaminated wounds
  • contaminated wounds
31
Q

Dirty wounds receive…

A

therapeutic antibiotics based on culture & sensitivity testing

32
Q

What serum concentrations of antibiotics should be used to fight an infection?

A

4-8x the MIC for the bacteria being treated

33
Q

Timing of administration should permit…

A

absorption & distribution to the target tissue without promoting bacterial resistance

34
Q

The first dose of surgical prophylactic antibiotics should be given…

A

IV 30-60 mins before the first skin incision
OR IM 1-2 hrs before first skin incision

35
Q

How often should prophylactic surgical antibiotics be repeated during surgery?

A

every 90-120 mins

36
Q

It is essential to repeat prophylactic surgical antibiotics if a procedure takes longer than

A

3 hrs

37
Q

What are the guidelines for therapeutic antibiotics?

A
  • initial selection based on the most likely organism and usual sensitivity pattern
  • drug must be able to reach the target tissue
  • continuing therapy based on culture and sensitivity testing
  • appropriate length of treatment varies w/ tissue, patient, and wound factors
    – appropriate wound management is critical

ICMS (22 decks)

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