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