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Small animal surgery I > Wound classification, infection and antimicrobial use > Flashcards

Wound classification, infection and antimicrobial use Flashcards

1
Q

Surgical wound are classified by degree of what?

A

Contamination

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2
Q

What does classification of surgical wounds predict?

A

Likelihood of infection

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3
Q

What number of organisms must be present in order to diagnose a bacterial infection?

A

> 100,000 organisms/gram of tissue

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4
Q

What are the 4 classifications of surgical wounds?

A
  1. Clean
  2. Clean contaminated
  3. Contaminated
  4. Dirty
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5
Q

T/F: A clean wound is a non-traumatic, non-infected operative wound

A

TRUE

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6
Q

In order to be classified as a clean wound, which tracts must NOT be entered? Examples?

A

Oropharyngeal, GIT, urinary, and respiratory tracts not entered

Ex: exploratory, neuter

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7
Q

What is a clean contaminated wound? What are some examples?

A

Clean wound in which tract is penetrated

No gross contamination

Ex: gastrotomy, hole in glove detected

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8
Q

Which wound classification does this describe:

Traumatic wound

No purulent discharge

Spillage of GIT contents or urine

Major aseptic break

A

Contaminated

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9
Q

What are two examples of a contaminated sx wound?

A

Bile spillage

Touched mask

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10
Q

Can a contaminated wound be converted to a clean contaminated wound?

A

Yes–early debridement and lavage can convert them

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11
Q

What classifies as dirty wounds?

A
  • Infected wounds
  • Wounds with pus
  • Perforated hollow viscus
  • > 100,000 organisms/gram of tissue
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12
Q

A ruptured stomach and cat fight abscess classify as which type of wound?

A

Dirty

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13
Q

T/F: All surgical wounds are contaminated by bacteria

A

TRUE

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14
Q

What is the incidence of infection for surgical wounds?

A

5%

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15
Q

What is the goal of aseptic technique?

A

Minimize the incidence of surgical wound infection

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16
Q

What are the degrees of bacterial contamination for each wound classification (percentages)?

A
  • Clean = 0-4.8%
  • Clean contaminated = 3.5-5%
  • Contaminated = 4.6-12%
  • Dirty = implies infection
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17
Q

How does clipping at the surgical site increase risk of contamination? How can you minimize that risk?

A

Leaves nicks in skin–>allows bacteria to colonize

Only clip immediately pre-operatively

18
Q

T/F: normal wound healing enhances the immune system

A

FALSE–it suppresses the immune system

19
Q

How can longer surgeries increase risk of infection?

A
  • Tissue trauma
  • Suture/hemostasis
  • Environmental exposure
20
Q

T/F: For duration of both surgery and anesthesia, risk of infection doubles every hour

A

TRUE

21
Q

Can prolonged exposure to anesthetic drugs suppress immunity?

A

YES

22
Q

T/F: Anesthetic drugs don’t have any chances of becoming contaminated

A

FALSE–some drugs are eaily contaminated

Ex: propofol can support microbial growth

23
Q

What 3 endocrinopathies are risk factors for infection?

A

Diabetes mellitus

Hyperadrenocorticism

Hypothyroidism

24
Q

Which sex has a higher risk factor for infection? Why?

A

Intact male cats and dogs

Androgens effect on the immune system

25
Q

T/F: The higher number of people in the OR, the higher the chance of infection in the patient

A

TRUE

26
Q

T/F: Supplemental oxygen may increase the risk of surgical wound infection

A

FALSE

27
Q

What is the difference between prophylactic and therapeutic antibiotics?

A
  • Prophylactic
    • Use of an antibiotic to protect a patient from an anticipated bacterial invasion
      • Administered prior to wound contamination
  • Therapeutic
    • Infection already exists and needs to be treated
28
Q

When should prophylactic antibiotics be used?

Examples?

A
  • If risk of infection is relatively high
    • Many clean contaminated procedure
    • Contaminated procedures
    • Patient factors (pre-existing prosthesis)
    • Type and length of sx (>90 min)
    • Surgeon experience
  • When an infection would be disastrous
    • Ex: total hip replacement
29
Q

Which is preferred when selecting antibiotics: -static or -cidal?

A

-cidal

30
Q

What bac. and antibiotic choice occurs in clean procedures?

A

Staphylococcus

Cephazolin

31
Q

What bac. and antibiotic choice occurs in clean contaminated procedures of the upper GIT?

A

Enterococci

Cephazolin

32
Q

What bac. and antibiotic choice occurs in clean contaminated wounds of the cecum and colon?

A

Anaerobes

Cefotoxin 2nd generation

33
Q

What is the goal of correct timing of prophylactic antibiotics?

A

To achieve highest concentrations at start of and duration of surgery

34
Q

When should prophylactic antibiotics be administered?

A

1 hour prior

Repeat every 2 hours during surgery

35
Q

When should prophylactic antibiotics NOT be delivered? Why? Is there an exception?

A
  • Do not administer beyond 24 hrs post surgery
    • Alters organism susceptibility
    • Increases infection rates
  • Unless gross contamination
    • Prophylactic becomes therapeutic
36
Q

When are preventative antibiotics used in surgery?

A
  • Intraoperative use when unexpected contamination occurs
    • Spillage of intestinal contents
  • Surgery longer than expected (>90 min)
37
Q

T/F: Intraoperative prevetative antibiotic use has been proven to be beneficial

A

FALSE

38
Q

What are the indications for therapeutic antibiotics?

A

Systemic infection

Surgical site infection

Any contaminated or dirty procedure

39
Q

What should therapeutic antibiotic choice be based on? When should it be given?

A

Based on C/S

Start prior to surgery and continue >2-3 days post surgery

40
Q

How can you minimize post-operative infections?

A

Use glove and wash hands

Protect/clean incisions

Drains and catheters

Small animal surgery I (25 decks)

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