PREVENTION AND TREATMENT of SURGICAL INFECTION

INTRODUCTION

The risk factors for developing a wound infection

The preoperative (prehospital) component The operative environment The microbial factors

CLASSIFICATION OF SURGICAL WOUNDS

CLASSIFICATION OF SURGICAL WOUNDS

Classification of Operative Wounds and Surgical infection rates

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

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

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

Remote-Site Infection and Shaving

The presence of a remote-site infection, whether it is a pustule, an upper respiratory infection, or urinary tract infection, needs to be identified and treated prior to any surgical intervention A patient whose surgical site has been shaved has an infection rate two to three times higher than patients who are not shaved The need for shaving a surgical site should be considered not for sanitary reasons but only for the convenience of the patients wound care.

Hand Washing

Shoe Covers, Caps, Masks, Gowns, and Gloves

Core Body Temperature

The presence of the cold environment in the operating room reduces the patients core body temperature This reduction in the patients core temperature significantly increases the risk of postoperative infection This requires meticulous attention to keeping the patient warm

Postoperative Care
Supportive therapy Monitoring Postoperative Fever Blood and radiographic tests Surgical Wound Management

Surgical Wound Management and Surgical Wound Infection Care

Topical Wound Treatment
CLOSED WOUNDS OPEN WOUNDS

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 6 weeks, wounds are at 70% of the tensile strength of normal skin, which is nearly the maximal tensile strength achieved by scar (75%-80% of normal).

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 25 days These wounds heal by contraction and epithelialization.

Secondary closure of wound

The wound is open, and the edges are not approximated. A potentially contaminated wound is best left open lightly packed with damp saline soaked gauze and the suture closed as delayed primary closure after 25 days

MICROBIAL FACTORS OF IMPORTANCE IN THE DEVELOPMENT OF INFECTION

Two major reservoirs: (1) host endogenous microflora (2) microbes within the external milieu, which often represents the nosocomial environment for hospitalized individuals

ANTIBIOTICS IN SURGERY
Prophylactic antibiotics Antibiotic Therapy

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 if there 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

Prophylactic antibiotics
Medical considerations that compromise the healing capacity or increase the infection risk: Diabetes
Peripheral vascular disease Possibility of gangrene or tetanus Immunocompromise

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.

Antibiotic Therapy
A narrow-spectrum antibiotic may be used to treat a known sensitive infection
Combinations of broad-spectrum antibiotics can be used when the organism is not known

Principles for the use of antibiotic therapy

Antibiotics do not replace surgical drainage of infection Only spreading infection or signs of systemic infection justifies the use of antibiotics Whenever possible, the organism and sensitivity should be Determined

Treatment of commensals that have become opportunist pathogens

They are likely to have multiple antibiotic resistance
It may be necessary to rotate antibiotics

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.

Thank You