Wound Classification, Infection and Antimicrobial Use

Question 1

What are the 4 classifications of operative wounds?

Answer 1

Clean
Clean-contaminated
Contaminated
Dirty

Question 2

What is a clean wound?

Answer 2

Surgically created wound

Question 3

What is a clean-contaminated wound (2 causes)?

Answer 3

Surgically created, but hollow organ normally containing bacteria opened, NO SPILLAGE
OR
Minor break in technique (hole in glove)

Question 4

What is a contaminated wound (3 causes)?

Answer 4

Surgical wound, but hollow organ opened with spillage (eg. emergency gastrotomy with no time for proper patient prep/fasting)
OR
Major break in technique
OR
Traumatic wound

Question 5

What is a dirty wound?

Answer 5

Contains pus or contents of perforated hollow organ

Question 6

What is the goal of aseptic technique?

Answer 6

Minimize incidence of surgical wound infection

Question 7

What is the rule of thumb for wound infections?

Answer 7

Risk doubles every hour

Question 8

Time is…

Answer 8

Trauma

Question 9

What is the most common source of bacteria?

Answer 9

Patients own flora

Question 10

Do steamclox tell you something is sterile?

Answer 10

No, just tells you autoclave got hot enough, but doesn’t say if it was hot enough long enough to kill bacteria.

Question 11

Define surgical site infection.

Answer 11

Infection at site within 30 days of surgery OR up to 1 year with implants

Question 12

What is the difference between prophylactic and therapeutic Abx use in surgery?

Answer 12

Prophylactic: Prior to wound contamination so already on board when surgery beings
Therapeutic: Infection already present

Question 13

When do you give prophylactic Abx and why?

Answer 13

30-60 minutes before incision, and prior to induction to assess drug reaction.

Question 14

When do you stop prophylactic Abx?

Answer 14

Terminated at end of sx, and no longer than 24 hours

Question 15

When do you use prophylactic Abx in surgery?

Answer 15

When risk of infection is high OR infection would be catastrophic to patient

Question 16

What Abx is most commonly used?

Answer 16

Cefazolin

Question 17

What ABX is most commonly used for GI surgeries?

Answer 17

Cefoxitin

Question 18

When do you give preventative Abx?

Answer 18

Given intraop. when unexpected contamination or surgery is longer than expected

Question 19

What should therapeutic Abx use be based on?

Answer 19

C/S if possible

Question 20

If no C/S is possible, on what do you base therapeutic Abx use?

Answer 20

Empiric tx (4 quadrants: G+, G-, Aerobes, Anaerobes)

Make sure to monitor response and re-culture if possible/necessary

Question 21

How can you minimize post-op infections? (1 general way, 3 specific ways)

Answer 21

Good nursing

• Protect incision lines
• Wash hands and wear gloves
• Remove catheters and drains as soon as no longer needed