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Flashcards in Post-op infections Deck (42):
1

Define surgical site infection

A type of healthcare associated infection which occurs after an invasive surgical procedure.

2

Name 2 other healthcare associated infections that affect surgical patients

Post-op respiratory infection
Urinary tract infection
Bacteraemia
ABX-related diarrhoea

3

What are the 2 commonest causes of surgical site infection?

Patients own flora:
Skin - Staph aura, staph epidermidis
Viscera - E. coli (GI), Pseudomonas (biliary)

4

Name 4 sources of surgical infection

Patient's own flora
Indirect contact
Direct inoculation
Airborne contamination
Haematogenous spread
Food and water
Faecal-oral
Insect bourne

5

What are the consequences of surgical site infection?

Increased morbidity and mortality
Extended hospitalisation
Cost

6

Name 2 pre-op measures to reduce surgical site infections

Patient shower before surgery
Hair removal using clippers
ABX prophylaxis when indicated

7

What are the indications for antibiotic prophylaxis in surgery?

Clean surgery involving insertion of prosthesis
Clean-contaminated surgery
Contaminated surgery

8

Name 2 intra-op measures to reduce surgical site infections

Antiseptic skin preparation
Hand decontamination and sterile gowns/gloves
Wound dressing

9

Name 2 post-op measures to reduce surgical site infections

Avoid unnecessary contact with wound for 48-72hr
Ensure clean hands and PPE
Involve tissue viability team if poor wound healing or infection
ABX if wound infected

10

Name 5 general risk factors for wound infection

Age
Malnutrition
Obesity
Smoking
Immunosuppression
Diabetes mellitus
Alcoholism
Jaundice
Chronic kidney disease
Hypoxia and anaemia

11

Name 3 local risk factors for wound infection

Type of surgery
Length of surgery
Necrotic tissue
Residual local malignancy
Foreign body
Ischaemia, haematoma

12

Name 2 microbiological risk factor for wound infection

Lack of ABX prophylaxis
Infectious organism

13

Name the 4 types of surgery

Clean
Clean contaminated
Contaminated
Dirty

14

What is the rate of surgical site infection for clean surgery?

<2%

15

What is the rate of surgical site infection for clean contaminated surgery?

<10%

16

What is the rate of surgical site infection for contaminated surgery?

15-20%

17

What is the rate of surgical site infection for dirty surgery?

>40%

18

Name 3 of the commonest bacteria seen with surgical site infections

Coagulase -ve staph e.g. Staph epidermidis (25%)
Enterococci (11.5%)
Staph aureus (9%)
Candida albicans (6.5%)
E. coli (6.3%)
Pseudomonas aeruginosa (6%)

19

Define clean surgery

An uninfected operative wound
No inflammation
Respiratory, GI, biliary, or genitourinary tract not entered

20

Define clean-contaminated surgery

Operative wound
Respiratory, GI, biliary, or genitourinary tract entered under controlled conditions
No unusual contamination

21

Define contaminated surgery

Open, fresh, or accidental wounds (<4hr)
Operations with major breaks in sterile technique or gross spillage from GI tract
Acute, non-purulent inflammation

22

Define dirty surgery

Old (>4hr) traumatic wounds with retained devitalised tissue, and those that involve existing clinical purulent infection

23

What are the 3 types of surgical site infection?

Superficial
Deep
Organ space

24

Define wound dehiscence

A surgical complication in which a wound ruptures along a surgical incision.

25

What is a complication of wound dehiscence of the abdomen?

Evisceration - viscera protrude through the wound

26

What is the commonest cause of wound dehiscence?

Secondary to surgical site infection

27

Outline the management of wound dehiscence

Initial: dress any exposed viscera, IV ABX if infected, drain pus

Superficial: regular lavage and dressing, consider vacuum-assisted closure

Deep: re-suture, vacuum-assisted closure

28

What are the symptoms of surgical site infection?

Pain and discharge in wound
Malaise, anorexia, fever

29

What are the signs of surgical site infection?

Fever, tachycardia
Red, swollen, tender wound
May be discharging pus

30

What factors increase the risk of post-op sepsis?

Immunosuppressed patient
ABX-resistant organism

31

What investigations should be sent in surgical site infection?

MCS of pus
FBC (Hb, WCC)
Blood cultures

32

What is the initial management of surgical site infections?

Appropriate ABX guided by microbiologist

33

Why are post-op respiratory infection common?

General anaesthetic irritates the respiratory tract.
Opioid analgesia inhibits cough reflex
Wound pain makes breathing and coughing more difficult

34

How are post-op respiratory infections treated?

Good analgesia post-op
Chest physiotherapy
Antibiotics

35

What is the most likely cause of post-op UTIs?

Catheter insertion

36

How long should a catheter remain in a patient?

Up to 4-5 days

37

How are post-op UTIs prevented?

Avoiding unnecessary catheterisation
Good aseptic technique
Remove at earliest time

38

What is the role of catheters during/after a surgical procedure?

Monitor fluid output to ensure adequate hydration and removal of metabolites.

39

What is the target urine output for the average patient?

0.5 ml/kg/hr

40

Which organism is associated with antibiotic-related diarrhoea

Clostridium difficile

41

Name 3 risk factors for C. difficile infection

Current or recent ABX use
Over 65
Recurrent or prolonged admission
Nursing home
Serious co-morbidites
Immunosuppression

42

Outline the management of C. difficile infection

Isolation
Fluids and electrolytes
Monitor daily
Stop causative ABX
Avoid work/school for 48hr after last episode

Mild: no specific ABX Tx

Mild-moderate: Metronidazole 500mg TDS for 10-14 days

Severe/recurrent: Vancomycin