Wound Healing COPY

Question 1

Obj: in a clinical scenario determine factors influencing infection risk and how to address them

Question 2

Ob: Discuss the steps and strategies used in surgeon and patient aseptic preparation

Question 3

Obj: Compare/Contrast different antiseptics for patient preparation

Question 4

Obj: given a clinical case scenario, determine appropriate antimicrobial usage

Question 5

obj: Define the four wound classifications and be able to classify procedures into each one

Question 6

What are Halstead’s Principles

Answer 6

• Strict aseptic technique
• Meticulous hemostasis
  
  • Using fine, non-irritating suture material in minimal amounts
• Gentle handling of tissue
• Sharp anatomic dissection of tissues
  
  • Preservation of vascularity
  • Removal of necrotic tissue
• Minimum tension of tissues
• Obliteration of dead space
• Importance of rest

Question 7

What are endogenous sources of microbial contamination?

Answer 7

• From the patient
• Normal flora
  
  • skin
  • GI tract
  • Lower Urinary tract
  • Upper respiratory
• Infection

Question 8

What are exogenous sources of microbial contamination?

Answer 8

• From the environment
  
  • Room air
  • clippers
  • Sx teams
  • Instrument/drapes
  • Dx/therapeutic devices
  • Implants

Question 9

What is aseptic tecnique?

Answer 9

• A combination of practices used to eliminate microorganisms within an operative field
• Goal is to minimize risk of infection by reducing or eliminating environmental factors, treatment factors, patient factors and pathogen factors

Question 10

What is the purpose of Draping

Answer 10

• Isolates the Sx site/personnel from contaminated areas
• Provides sterile working area

Question 11

What factors contribute to Surgical Site Infections?

Answer 11

• Pathogen Factors
• Patent Factors
• Environmental Factors
• Treatment Factors

Question 12

What are the treatment factors that contribute to SSI?

Answer 12

• Use of drains
• Perioperative hypothermia/hypotension
• Blood loss
• Implants placed
• Duration of surgery (>90min)
• ASA Status
• Duration of anesthesia (>120min)
• Surgeon experience
• Prolonged hospitalization

Question 13

What are the Patent factors that contribute to SSI?

Answer 13

• Sex (males > females minor)
• Age (old > young minor)
• Endocrinopathies (could be mayor or minor)
• Immunosuppression (major)
• Obesity or malnutrition (minor)
• Recent surgery (major)
• Prior site irradiation (major)
• Pyoderma (major)

Question 14

What are the Pathogen factors that contribute to SSI?

Answer 14

• Type of bacteria
• # of microbes
  • reduce through antiseptics or antimicrobials
• Virulence

Question 15

What are the common bacteria encountered on the skin?

Answer 15

• Staphylococcus*
• Streptococcus*

Question 16

What are the common bacteria encountered on the upper GI?

Answer 16

Mostly gram + cocci

Question 17

What are the common bacteria encountered on the lower GI?

Answer 17

anaerobes and gram negative bacilli

Question 18

What are the common bacteria encountered on the genitourinary tract?

Answer 18

Gram negative bacilli

Question 19

When and what type of antimicrobials should be used?

Answer 19

• Dirty wound /procedures
  
  • therapeutic antimicrobials
• Clean-contaminated or Contaminated wounds/procedures
  
  • Prophylactic antimicrobials
  • Maybe therapeutic use
• Clean procedures
  
  • No antimicrobials unless:
    
    • high risk surgeries
    • patient has major risk factor or multiple minor risk factors

Question 20

Which antimicrobials should be used?

Answer 20

• Skin/Upper GI - Penicillins or 1st gen cephalosporin
• Lower genitourinary - broad spectrum
• Lower Gi - cephalosporin + fluoroquinolone OR broad spectrum
• Infections - start broad spectrum then change based on culture results