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SURGICAL INFECTION

SURGICAL INFECTION . DR IMRANA AZIZ ASSISTANT PROFESSOR SURGERY. A CLASSIFICATION OF WOUNDS. CLEAN CLEAN CONTAMINATED CONTAMINATED DIRTY. PREDISPOSING FACTORS OF DEVELOPING INFECTION. MALNUTRITION METABOLIC CAUSES IMMUNOSPPRESSION COLONISATION POOR PERFUSION FOREIGN BODY

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SURGICAL INFECTION

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  1. SURGICAL INFECTION DR IMRANA AZIZ ASSISTANT PROFESSOR SURGERY

  2. A CLASSIFICATION OF WOUNDS • CLEAN • CLEAN CONTAMINATED • CONTAMINATED • DIRTY

  3. PREDISPOSING FACTORS OF DEVELOPING INFECTION • MALNUTRITION • METABOLIC CAUSES • IMMUNOSPPRESSION • COLONISATION • POOR PERFUSION • FOREIGN BODY • POOR SURGICAL TECHNIQUE

  4. SOURCES OF INFECTION • PRIMARY • SECONDARY

  5. WOUND GRADING SYSTEM • SOUTHHAMPTON WOUND GRADING SYSTEM • THE ASEPSIS WOUND SCORE

  6. O Normal healing L Normal healing with mild bruising La Some bruising Lb Considerable bruising Lc Mild erythema Ll Eyrthema plus other signs of inflammation Lla At one point Llb Around sutures Llc Along wound Lld Around wound Lll Clear or haemoserous discharge Llla At one point on (≤ 2 cm) Lllb Along wound (> 2 cm Lllc larger Volume Llld Prolonged (> 3 days) Major Complications IV Pus IVa At one point only (≤ 2 cm) IVb Along wound (> 2 cm) V Deep or severe wound infection with or without tissue breakdown; haematoma requiring aspiration

  7. Criteria Points Additional treatment 0 Antibiotics for wound infection 10 Drainage of pus under local anaesthesia 5 Debridement of wound under general anaesthesia 10 Serous discharge* Daily 0-5 Erythema Daily 0-5 Purulent exudate* Daily 0-10 Separation of deep tissues* Daily 0-10 Isolation of bacteria form wound 10 Stay as in-patient prolonged over 14 days as result of wound infection 5

  8. TYPES OF INFECTION • LOCALISED INFECTION ABSCESS CELLULITIS LYMPHANGITIS • SYSTEMIC INFECTION SSI SIRS MODS MSOF

  9. ABCESS • IT IS A LOCALISED COLLECTION OF SUPPURATIVE INFECTION CAUSING SWELLING AND INFLAMMATION • MAY PRESENT AS SUPERFICIAL OR DEEP • CLINICAL FEATURES:CALOR,RUBOR DOLOR , TUMOUR • MANAGEMENT: ANTIBIOTICS DRAINAGE AND CURRETAGE DRAINAGE UNDER GUIDANCE (U/S, MRI,CT)

  10. CELLULITIS • CELLULITIS IS NON SUPPURATIVE INVASIVE INFECTION OF TISSUES • B HAEMOLYTIC STREPTOCOCCI • CLINICAL FEATURES: SIRS,TOXEMIA(FEVER,CHILLS RIGORS,TACHYCARDIA,TACHYPNOEA) • MANAGEMENT:BROAD SPECTRUM ANTIBOTICS

  11. SYSTEMIC INFLAMMATORY RESPONSE SYNDROME • SSI:SURGICSL SITE INFECTION SSI IS DEFINED AS WOUND THAT EITHER DISCARGES SIGNIFICANT QUANTITY OF PUS SPONTANEOUSLY OR NEEDS A SECONDARY PROCDURE TO DRAIN IT • SIRS:SYSTEMIC INFLAMMTORY RESPONSE SYNDROMES • MODS: MULTIPLE ORGAN DYSFUNCTION • MSOF: MULTI SUSTEM ORGAN FAILURE

  12. SIRS HYPERTHERMIA (>38 C)OR HYPOTHERMIA(<36 C) TACHYCARDIA(>90/MINOR TACHYPNOEA(>20 /MIN) WHITE CELL COUNT12X10(9) 4X10(9)

  13. SPECIFIC WOUND INFECTIONS • GAS GANGRENE • TETANUS • NECROTISING FASCITIS

  14. TETANUS • C.TETANI:ANAEROBIC,SPORE BEARING,GRAM POSITIVE RELEASES EXOTOXIN TETANOSPASMIN • CLINICAL FEATURES: TETANOSPASMINACTS ON MYONEURONAL JUNCTIONS AND MOTOR NEURONES OF ANTERIOR HORN OF THE SPINAL CORD SHORT PRODROMAL PERIOD:SEVERE MOTOR SPASMS(RESPIRATORY DISTRESS,OPISTHOTONUS ,RISUS SARDONICUS ) LONG PRODROMAL PERIOD MILD INFECTION • MANAGEMENT:TETANUS TOXOID PROPHYLAXIS HUMAN ANTI TOXIN FOR ESTABLISHED WOUNDS BENZYPENCILLIN

  15. NECROTISING FASCITIS • POLYMICROBIAL SYNERGISTIC INFECTION • COLIFORMS,STAPHYLOCOCCI,BACTEROIDES , ANAEROBIC STREPTOCOCCIAND PEPTOSTREPTOCOCCI • MELENEYS GANGRENE • FOURNIERS GANGRENE • MANAGEMENT:BROAD SPECTRUM ANTIBIOTIC THERAPY WITH CIRCULATORY SUPPORT EXCISION AND EXTENSIVE DEBRIDEMENT OF NECROTIC TISSUE SKIN GRAFTING

  16. GAS GANGRENE • C.PERFRINGENS:ANAEROBIC SPORE BEARING GRAM POSITIVE • PREDIPOSING FACTORS:TRAUMATIC MILITTARY WOUNDS ,IMMUNOCOMPROMISED • CLINICAL FEATURES:OEDMA ,CREPITUS,SKIN BLISTERING ,FEVER,GREYISH SWEET SMELLING DISCHARGE IF NOT TREATED SHOCK ,COAGULOPATHY,MULTIORGAN FAILURE • MANAGEMENT:INTRAVENOUS PENCILLINS , HYPERBARIC OXYGEN

  17. MANAGEMENT OF WOUND INFECTION • ANTIBIOTICS:PROPHYLAXIS • CULTURE SPECIFIC • DRAINAGE AND DRESSINGS • DELAYED CLOSURES

  18. PREVENTIVE MEASURES • PREOOERATIVE PREPARATION: OPTIMUM PATIENTS CONDITION,EMPIRICAL ANTIBIOTIC COVER ,ASPETIC CONDITIONS,SHAVING, WASHING HANDS • OPERATIVE;METICULOUS OPERATIVE MANIPULATION • AVOID HYPOXIA,HYPOTHERMIA • POSTOOERATIVE:MRSA

  19. SURGEON SAFTEY • USE OF FULL FACE MASK,EYE GOOGLES • WATERPROOF DISPOSABLA GOWNS • DOUBLE GLOVING • ESSENTIAL PERSONAL • AVOID DIRECT SHARP OBJECT HANDLING • PROPER WASTE DISPOSALE

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