surgical infections control
DESCRIPTION
TRANSCRIPT
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SURGICAL INFECTIONS
By Dr. Ahmed Mustafa
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SURGICAL INFECTIONS
Infections that require surgical treatment or
related to operative interventions
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SURGICAL INFECTIONS Infections required surgical
treatment • Necrotizing soft tissue infections • Infections of body cavities
(peritonitis, empyema, etc.) • Infections confined to an organ or
tissue (abscesses, septic arthritis, cholecystitis, etc)
• Prosthetic device infections
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SURGICAL INFECTIONS INFECTIONS RELATED TO OPERATIVE
INTERVENTION • Wound infections - Surgical site
infections • Postoperative infections (peritonitis or other cavity
infections) • Surgical nosocomial infections (pneumonia, urinary tract infections,
catheter infections)
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NOSOCOMIAL INFECTIONS
Occurs after the initial 48 hours of admission
• Urinary tract infection • (IV) Catheter-related infection • Lower respiratory tract
infection • Infection via transfusion • Bacteriemia and Sepsis
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PATHOGENESIS DETERMINANTS OF INFECTIONS Microorganism Host Defenses (virulance) (type&severity of
immunosupression) INFECTION Environment (Fluids, foreign bodies, a
closed unperfused space etc.)
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Infectious agent The Endogenous Gastrointestinal
Microflora • Stomach • Duodenum Aerobes and anaerobes • Proximal small bowel <104/mL • Distal small bowel
Enterobacteriaceae Enterococcus spp 103-108/mL Anaerobic organisms
• Colon Anaerobic organisms Bacteriodes fragilis 1012/mL
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Microbiology of Intraabdominal Infections
Aerobes: Escerichia coli Klebsiella spp. Proteus spp Enterobacter spp Enterococcus spp Anaerobes: Bacteriodes spp Peptostreptococcus spp Clostridium spp Bilophila wadsworthia Fungi,Candida
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HOST DEFENSE MECHANISMS
Nonspecific Surface Mechanical barrier (skin, mucosa) Secretory
barrier Immunoglobulins Ciliary motion Movement
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HOST DEFENSE MECHANISMS
Specific Cellular defense Phagocytic cells
Cell-mediated immunity (PNLs, eosinophils, mononuclear cells) (T lymphocytes & macrophages)
Natural killer cells Humoral defense Lyzozyme
Immunoglobulins Complement Interferon
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A Susceptible host Causes of Impaired Host Resistance to Infection Patient’s Underlying Condition • AIDS • Remote infection • Neoplasia • Malnutrition • Acute stress (burns, trauma) • Metabolic illness (DM, uremia) • Aging • Obesity • Smoking
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A Susceptible host Iatrogenic • Antineoplastic chemotherapy • Immunosuppressive therapy (allograft recipients, autoimmune disorders) • Splenectomy
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Infection Environment
Wound or a natural space with narrow outlets
Fluids, foreign bodies, a closed unperfused space etc
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Clinical finding LOCAL MANIFESTATIONS OF SURGICAL
INFECTIONS • CELLULITIS: Spreading infection of the skin
and subcutaneous tissue • LYMPHANGITIS: Inflammation of the
lymphatic channels in the subcutaneous tissue
• ABSCESS: Localized accumulation of purulent
material situated in the dermis or subcutaneous
tissue
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SURGICAL SITE INFECTION
The term “surgical site infection” now replaces “surgical wound infection”
• Superficial incisional SSI; involves the skin or subcutaneous
tissue • Deep incisional SSI; involves the deep tissue such as
fascia or muscle,Organ/space SSI
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SURGICAL SITE INFECTIONDEFINITION
Superficial Incisional Infection Any incisional infection occuring within
postoperative 30 days at any level above fascia described as;
• Presence of any purulant discharge (culture may not reveal any opponent)
• Any positive culture findings from primarily closed incision
• Deleberate incision exploration • Infection diagnosis determined by the
surgeon
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SURGICAL SITE INFECTIONDEFINITION
Deep Incisional /Organ / Space Infection Any infection occuring within postoperative
30 days or within postoperative one year if any implant is left
described as; • Presence of any purulant discharge (through
drains) • Any positive culture findings from
intraabdominal samples • Spontaneous wound dehiscence • Presence of abscess • Infection diagnosis determined by the
surgeon
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Diagnosis
• Redness • Swelling • Hyperthermia • Fluctuation • Purulent or turbid aspirate
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OPERATIVE WOUNDS
NATIONAL RESEARCH COUNCIL CLASSIFICATION OF OPERATIVE WOUNDS
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CLASSIFICATION OF OPERATIVE WOUNDS
CLEAN • Nontraumatic • No inflammation encountered • No break in technique • Respiratory, alimentary,
genitourinary tracts not entered
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CLASSIFICATION OF OPERATIVE WOUNDS
CLEAN CONTAMINATED • Gastrointestinal or respiratory tracts
entered without significant spillage • Appendectomy • Oropharynx entered • Vagina entered • Genitourinary tract entered in absence
of infected urine • Biliary tract entered in absence of
infected bile • Minor break in technique
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CLASSIFICATION OF OPERATIVE WOUNDS
CONTAMINATED • Major break in technique • Gross spillage from
gastrointestinal tract • Traumatic wound, fresh • Entrance of genitourinary or
biliary tracts in presence of infected urine or bile
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CLASSIFICATION OF OPERATIVE WOUNDS
DIRTY and INFECTED • Acute bacterial inflammation
encountered, without pus • Transection of clean tissue for the
purpose of surgical access to a collection of pus
• Traumatic wound with retained devitalized tissue,foreign bodies, fecal contamination, and/or delayed treatment, or from dirty source.
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Treatment Principles of Antibiotic Therapy • Why to use antibiotics? • Where is infection? • What are the most probable
pathogens? • How about antibiotic susceptibility? • Pharmacological properties • Is combination of antibiotics
necessary? • Host factors • Monitoring accuracy of therapy