View
226
Download
0
Category
Preview:
Citation preview
7/28/2019 Hannan Surgical Infections Talk
1/29
Surgical Infections
MS-3 Surgery Clerkship Lecture
Natalia Hannan M.D.
07/05/11
7/28/2019 Hannan Surgical Infections Talk
2/29
Ignaz Semmelweis
1847
Realized that washing
hand with a chlorinatedlime solution decreased
incidence of newborn
death from puerperalfever.
7/28/2019 Hannan Surgical Infections Talk
3/29
Joseph Lister
1883-1897
British surgeon
Used Carbolic Acid(Phenol) to cleanhands, instruments
and wipe on surgicalwounds drasticallydecreased infections.
7/28/2019 Hannan Surgical Infections Talk
4/29
Overview
Recognizing Infection
Soft Tissue Infections
Post-operative Infections
Surgical Site Infection
Hospital Acquired Infections
Antibiotic Prophylaxis
Blood Born Pathogens
7/28/2019 Hannan Surgical Infections Talk
5/29
Infection
Infection is defined by:
1. Microorganisms in host tissue or
the bloodstream
2. Inflammatory response to theirpresence.
7/28/2019 Hannan Surgical Infections Talk
6/29
7/28/2019 Hannan Surgical Infections Talk
7/29
Inflammatory Response
Localized:
Rubor, Calor, Dolor, Tumor, and functio
laesa (loss of function)
Systemic:
Systemic Inflammatory Response Syndrome
(SIRS)
7/28/2019 Hannan Surgical Infections Talk
8/29
S.I.R.S.
Any Two of the Following Criteria
1. Temperature: < 36.0, >38.0
2. Heart Rate : >90
3. Respiratory Rate: >20
4. WBC: 12,000
7/28/2019 Hannan Surgical Infections Talk
9/29
Sepsis
Definition: SIRS plus evidence of local
or systemic infection.
Septic Shock
Definition: Sepsis plus end organhypoprofusion. Mortality of up to
40%
7/28/2019 Hannan Surgical Infections Talk
10/29
Soft Tissue Infections:
1. Cellulitis
2. Abscess
3. Necrotizing Infections
7/28/2019 Hannan Surgical Infections Talk
11/29
Cellulitis
7/28/2019 Hannan Surgical Infections Talk
12/29
Cellulitis
Definition: Diffuse infection with severeinflammation of dermal andsubcutaneous layers of the skin
Diagnosis: Pain, Warmth, Hyperesthesia
Treatment: Antibiotics.
Common Pathogens: Skin Flora
(Streptococcus/Staphylococcus)
7/28/2019 Hannan Surgical Infections Talk
13/29
Abscess
7/28/2019 Hannan Surgical Infections Talk
14/29
Abscess
Definition: Infectious accumulation ofpurulent material (Neutrophils) in a
closed cavity
Diagnosis: Fluctuant: Moveable and
compressible
Treatment: Drainage
7/28/2019 Hannan Surgical Infections Talk
15/29
Necrotizing Soft Tissue
Infection
7/28/2019 Hannan Surgical Infections Talk
16/29
Necrotizing Soft Tissue
Infection
Definition: Deep infection of skin and soft tissuethat may spread rapidly along facial planes.
Diagnosis: Purely Clinical, dishwater discharge,gray tissue, pain out of proportion toexamination, bulla, and dark, golden
discoloration.
Treatment: True Surgical Emergency, Antibiotics
7/28/2019 Hannan Surgical Infections Talk
17/29
Necrotizing Soft Tissue
Infection Common Pathogens
Clostridium
Group A streptococcus
Polymicrobial
Toxic Shock Syndrome Streptococcus
Staphylococcus
7/28/2019 Hannan Surgical Infections Talk
18/29
Post-Operative Infections
Fever After Surgery
The Five Ws
Wind: Atelectisis
Water: UTI
Walking: DVT
Wonder Drug: Medication Induced
Wound: Surgical Site Infection
7/28/2019 Hannan Surgical Infections Talk
19/29
Surgical Site Infections
3rd most common hospital infection
Incisional
Superficial
Deep
Organ Space
Generalized (peritonitis)
Abscess
7/28/2019 Hannan Surgical Infections Talk
20/29
7/28/2019 Hannan Surgical Infections Talk
21/29
Types of Surgery
Clean Hernia repair
breast biopsy
1.5%
Clean-
Contaminated
Cholecystectomy
planned bowel resection
2-5%
Contaminated Non-preped bowel
resection
5-30%
Dirty/infected perforation, abscess 5-30%
7/28/2019 Hannan Surgical Infections Talk
22/29
Host Risk Factors
Diabetes mellitus
Hypoxemia
Hypothermia
Leukopenia
Nicotine (tobacco smoking)
Immunosuppression
Malnutrition
Poor skin hygiene
7/28/2019 Hannan Surgical Infections Talk
23/29
Perioperative Risk
Factors Operative site shaving
Breaks in operative sterile technique
Improper antimicrobial prophylaxis
Prolonged hypotension
Contaminated operating room
Poor wound care postoperatively
Hyperglycemia
Wound closure technique
7/28/2019 Hannan Surgical Infections Talk
24/29
Treatment
Incisional: open surgical wound,
antibiotics for cellulitis or sepsis
Deep/Organ space: Source control,
antibiotics for sepsis
7/28/2019 Hannan Surgical Infections Talk
25/29
Operative Antibiotic
Prophylaxis Decreases bacterial counts at surgical site
Given within 30 minutes prior to startingsurgery
Vancomycin 1-2 hours prior to surgery
Redose for longer surgery Do not continue beyond 24 hours
7/28/2019 Hannan Surgical Infections Talk
26/29
7/28/2019 Hannan Surgical Infections Talk
27/29
Other Hospital Acquired
Infections
1. Urinary Tract Infection2. Indwelling Catheter Infection
3. Pneumonia
7/28/2019 Hannan Surgical Infections Talk
28/29
Use/Choice of Antibiotics
Use only when indicated
Start with broad spectrum antibiotics
designed to cover likely pathogens
Take cultures when possible
Deescalate spectrum once pathogen is
know
Have a plan for duration
7/28/2019 Hannan Surgical Infections Talk
29/29
Occupational Blood
Bourne Virus InfectionsHBV HCV HIV
Risk from
Needle stick
30% 2% 0.3%
Chemoprophylaxis Yes No Yes
Vaccine Yes No No
Recommended