Wound Classification, Wound Infection, Antibicrobial Use Flashcards
What are the classifications of operative wounds?
Clean
Clean contaminated
Contaminated
Dirty
What is an example of a clean wound?
Surgically created wound
no infection encountered
aseptic technique maintained
no structure normally containing bacteria opened
What is an example of a clean-contaminated wound?
Surgically created wound but…
hollow viscus or organ normally containing bacteria is opened but no contents are spilled
minor break in aseptic technique occurs
What is an example of a contaminated wound?
Hollow viscus is opend w/ gross spillage
Traumatic wound - always considered contaminated no matter how clean it looks!
What is an example of a dirty wound?
Contains pus
contains contents of perforated hollow viscus
How does operative wound classification affect the incidence of postoperative infections?
The incidence goes up the higher (dirtier) the classification goes
from 0-4.4% at Clean
- 5-9.5% at Clean-contaminated
- 8-28.6% Contaminated
and Dirty implies infection!
What are the factors that affect the development of postoperative wound infections?
Microbial pathogens
Local wound environment
Host defense mechanisms
How do anesthesia time, surgical time, body temperature, etc affect the incidence of post op infections
Risk of infection doubles every hour of surgery (incl. anesthesia)
Time is Trauma
Pts endogenous flora is most common source of pathogens
Skin, GIT
What is difference between prophylactic, preventative & therapeutic antibiotic administration
Prophylactic: Administered PRIOR to wound contamination
- prior to induction, 30-60 min before skin incision*
- continued perioperatively but not longer than 24 hours*
Preventative: Intraoperative administration of antibiotics when unexpected contamination occurs during sx or sx longer than expected
has not been shown to decr incidence of infection
Therapeutic: Infection already present
- should be based on C/S if possible*
- Empiric tx: 4 quad coverage*
- G+, G-, Aerobes, Anaerobes*
What are the indications for prophylactic AB admin?
Risk of infection high or infection would have catastrophic results
Pt. factors, type & length of sx, experience of surgeon
What are the guidelines for prophylactic AB admin?
Administered PRIOR to sx
30-60 min prior to skin incision, con’t no longer than 24 hours post op
single agent
-cidal dose
What are 2 common ABs used prophylactically
Cefazolin
Cefoxitin - GIT, particularly colon or when obstruction present
