week 7 lecture

Question 1

what are some of the key examples of surgical site infections?

Answer 1

wound discharge, dehiscence (coming apart of wound), lymphadenitis (inflammation of lymph nodes), formation of abscesses, necrosis (tissue death), gangrene, sepsis, induration (hardening of tissue/sclerosis with inflammation)

Question 2

what are some of the possible consequences of SSIs?

Answer 2

microbial penetration of deeper tissues; invasion of bloodstream (bacteraemia, sepsis); spread of bacteria to other sites (e.g. heart valves, bone, peritoneum)

Question 3

what are some of the key causes of SSIs?

Answer 3

contamination of incision by normal microbiota; presence of foreign bodies which attract bacteria and make it easier for them to reproduce; etc

Question 4

what are the 4 cases of surgical wounds?

Answer 4

clean (class I) - elective surgery which does not involve GI, R or GU tracts; clean/contaminated (class II) - urgent/emergency care - uncomplicated R, GI or GU tract surgery; contaminated (class III) - outside object comes into contact with wound, large amounts of spillage form GI tract into wound; dirty (class IV) purulent inflammation, foreign object lodged into wound (e.g. gunshot wound), traumatic or infected wound.

Question 5

what is prophylaxis?

Answer 5

the treatment with antibiotics BEFORE infection

Question 6

what are the types of bacteria found on the skin which can cause SSIs?

Answer 6

staphylococcus aureus, streptococci spp., enterococci spp.

Question 7

what are the types of bacteria found in the bowel which can cause SSIs?

Answer 7

E. coli, bacteroides fragilis, clostridium perfringens, enterococci spp., anaerobic cocci

Question 8

is it better to shave hair before surgery?

Answer 8

No, as shaving damages skin. It is better to use clippers.

Question 9

what are the two different solutions used to decontaminate patients’ skin?

Answer 9

alcoholic chlorhexidine and povidone iodine

Question 10

what are occlusive dressings?

Answer 10

air and water tight dressings

Question 11

what are tulle gras dressings?

Answer 11

gauze dressing impregnated with paraffin to prevent sticking

Question 12

what type of wound healing would you NOT use topical antimicrobial agents for?

Answer 12

primary intention wounds

Question 13

what type of infections does physiotherapy prevent while in hospital?

Answer 13

URTIs and UTIs

Question 14

what type of prosthetic joint infection might present at a month or earlier?

Answer 14

fulimant with wound sepsis

Question 15

what type of prosthetic joint infection might present as a delayed infection? (after less than a year)

Answer 15

indolent, low grade infection

Question 16

what type of prosthetic joint infection might present as a late onset infection (after more than 2 years)

Answer 16

septic arthritis

Question 17

what are some tests that can be done to determine if there is a prosthetic joint infection?

Answer 17

blood culture, collection of pus by needle aspiration, bone biopsy, raised Erythrocyte Sedimentation Rate (ESR) and C-reactive protein count (CRP), polymorphonuclear leucocytes and radiological imaging.