1.prevention and treatment of surgical infection

8/13/2019 1.Prevention and Treatment of Surgical Infection

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INTRODUCTION


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The risk factors for developing awound infection

The preoperative (prehospital) component The operative environment

The microbial factors


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CLASSIFICATION OF SURGICAL WOUNDS


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CLASSIFICATION OF SURGICAL WOUNDS


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Classification of Operative Wounds

and Surgical infection rates


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Health care-associated infection (HAI) /Nosocomial Infections in Surgical Patients

Potential sites: UTIs Pneumonia surgical site (wound) infections (SSIs) bloodstream infection bacteremia


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Principles Of Prevention To Infection

Preoperative Shower Remote-Site Infection and Shaving Hand Washing Shoe Covers, Caps, Masks, Gowns, and Gloves Core Body Temperature Postoperative Care Surgical Wound Management and Surgical

Wound Infection Care


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Remote-Site Infection and Shaving

The presence of a remote-site infection,whether it is a pustule, an upper respiratoryinfection, or urinary tract infection, needs to beidentified and treated prior to any surgicalintervention

A patient whose surgical site has been shavedhas an infection rate two to three times higher than patients who are not shaved

The need for shaving a surgical site should beconsidered not for sanitary reasons but only forthe convenience of the patients wound care .


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Hand Washing


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Shoe Covers, Caps, Masks, Gowns,

and Gloves


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Core Body Temperature

The presence of the cold environment in theoperating room reduces the patients core bodytemperature

This reduction in the patients core temperaturesignificantly increases the risk of postoperativeinfection

This requires meticulous attention to keeping thepatient warm


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Postoperative Care

Supportive therapy Monitoring Postoperative Fever

Blood and radiographic tests Surgical Wound Management


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Surgical Wound Management and

Surgical Wound Infection Care Topical Wound Treatment

CLOSED WOUNDS

OPEN WOUNDS


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Closed wound

Healing by primary intention Closed wounds should be kept sterile for 24-48 h until

epithelialization is complete Tensile strength is only 200/0 of normal skin at 3 weeks

when collagen cross-linking is becoming significant. At 6weeks, wounds are at 70% of the tensile strength of normalskin, which is nearly the maximal tensile strength achievedby scar (75%-80% of normal).


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Open Wound Necrotic material should be removed Open wounds heal optimally in a moist, sterile environment The wound is open, and the edges are not approximated The suture closed as delayed primary closure after 2 5 days These wounds heal by contraction and epithelialization.


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Secondary closure of wound

The wound is open, and the edges are not approximated. A

potentially contaminated wound is best left open lightly packedwith damp saline soaked gauze and the suture closed as delayedprimary closure after 2 5 days


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MICROBIAL FACTORS OF IMPORTANCE IN

THE DEVELOPMENT OF INFECTION

Two major reservoirs :(1) host endogenous microflora

(2) microbes within the external milieu, whichoften represents the nosocomialenvironment for hospitalized individuals


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Prophylactic antibiotics Empirical cover against expected pathogens with local

hospital guidelines Single-shot intravenous administration at induction of

anaesthesia

Repeat only in prosthetic surgery, long operations or ifthere is excessive blood loss Continue as therapy if there is unexpected

contamination Patients with heart valve disease or a prosthesis should

be protected from bacteraemia caused by dental work,urethral instrumentation or visceral surgery


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Prophylactic antibiotics

Medical considerations that compromise thehealing capacity or increase the infection risk :

Diabetes Peripheral vascular disease Possibility of gangrene or tetanus Immunocompromise


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Prophylactic antibiotics

High-risk wounds or situations: Penetrating wounds Abdominal trauma Compound fractures Wounds with devitalized tissue Lacerations greater than 5 cm or stellate lacerations

Contaminated wounds High risk anatomical sites such as hand or foot Biliary and bowel surgery.


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Antibiotic Therapy

A narrow-spectrum antibiotic may be used totreat a known sensitive infection

Combinations of broad-spectrum antibioticscan be used when the organism is not known


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Principles for the use of antibiotictherapy

Antibiotics do not replace surgical drainage ofinfection

Only spreading infection or signs of systemic

infection justifies the use of antibiotics Whenever possible, the organism and sensitivity

should be Determined


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HIV, AIDS AND THE SURGEON

Involvement of surgeons with HIV patients(universal precautions):

use of a full face mask ideally, or protective spectacles; use of fully waterproof, disposable gowns and drapes,particularly during seroconversion; boots to be worn, not clogs, to avoid injury from dropped

sharps; double gloving needed allow only essential personnel in theatre; avoid unnecessary movement in theatre; respect is required for sharps, with passage in a kidney dish; a slow meticulous operative technique is needed with

minimised bleeding .


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Thank You

1.prevention and treatment of surgical infection

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