INFECTIONHow are organisms transmitted?

Direct Contact

1. Person to Person2. Staff to Patient3. Patient to Staff

Indirect Contact• Other way than touching an infected person

• Fomite- Inanimate object 1. Dust 2. Moisture droplet- aerosol effect -talking -washing instruments 3. Food - cream pie 4. Water - stream 5. OR table 6. Drinking cup Vector- Something capable of moving organisms by itself Flies Tics Mosquitoes

What is necessary for infection to occur?

Invasion into the body• Pathogenic organisms enter• Pathways 1. Body orifices 2. Ducts 3. Lumen of broken vessel a. Veins have sinuses and low pressure b. CNS has rich nutrients and low pressure

Condition of patient

• Decreased inflammatory response• Absence of anatomic barriers• Local spread of organisms on/in surface of wound -Necrotic tissue• Systemic -Colonies increase -Can be carried throughout the body(Any body fluid/substance is potential carrier of pathogens) -Lymphatic system -Blood-borne• Major organs effected• Multisystem organ failure and death

Number (dose)• Grow in a system or localized area• Supported by -Warmth -Darkness -Moisture -Neutral pH -Nutrients

Virulence and Toxigenicity

• Presence of spores, capsules, etc.

• The relative ability of a microbe to cause disease• Ability to make toxins: -Endotoxins=from the cells of dead microorganisms -Exotoxins=From the living cell

PORTALS OF ENTRY• Eyes• Ears• Nose• Mouth (respiratory tract, gastrointestinal)• Urethra• Vagina• Rectum• Broken skin• Placenta

Portals of Exit

• Eyes• Ears• Nose• Mouth (respiratory tract, gastrointestinal)• Urethra• Vagina• Rectum• Broken skin

PROTECTION

• Standard Precautions 1. How to protect your portals of entry2. Potentially infectious-Considering that

everyone could potentially have an infection, even though they may not know.

Potentially Infectious Materials

• Blood and body fluids• Urine• Fecal material• Respiratory secretions• Saliva• Tears• Semen and Vaginal Secretions• Breast milk

CDC—Center For Disease Control

• 2 million acquire nosocomial infections• 77,000 die• Costs 4 + billion dollars to treat

Considerations for Nosocomial Infections

• Identify the reservoir• ID the portal of exit from the reservoir• ID how they are transmitted• ID invasion of the susceptible host

Infectious Process

• Local infections -Occur as a result of: a. Preoperative Injury b. Postoperative complication (usually begins

between the 4th and 8th post op day; usually begins with inflammation

c. Abscess formation (inflammatory response, Tissue liquefaction and pus formation)

Regional Infection

• Localization by abscess formation fails• Spreads 1) carried from primary site by lymphatic

system ( spreads to other areas; Lymphangitis)

2) Failure by nodes to control (uncontrolled cellulitis; may become systemic

Systemic Infection

• Chills, fever, signs of toxicity• Septic emboli enter circulation (causes

infection/abscess formation in remote tissues• Increases metabolism (stresses body organs,

produces septic shock)

• GOAL is To Prevent Infection

Once Infection has Occurred

• Identify the organism (s)• Identify the hosts immune response 1. Immunologic and inflammatory response 2. Lysis of microorganisms 3. Resorption of pus 4. Sloughing of necrotic tissue 5. Healing occurs

Appropriate Treatment

• Drain• Debridement• Antibiotics

Who is at Risk?

• Perioperative Staff

• Patient

Perioperative Staff

• Protect with PPE’s (Standard Precautions)• Risk is proportionate to proximity to patient• Increased risk of needle sticks and punctures

See statistics: Blue Packet Page 4

Patient• Needle sticks may stick the staff first

• Some are vulnerable to infection: 1. Immunosuppression 2. Immature immune system 3. Radiation Therapy 4. Burns 5. Diabetes 6. Nutritional depletion 7. Smoking and Alcoholism 8. Chemotherapy 9. Older Patients 10. Steroid Use 11. Sickle cell disease 12. Liver and Kidney Disease 13. Pre existing infection 14. Being treated with antibiotics SUPER INFECTION

Sources of Infection

• Exogenous infection = Acquired from sources outside the body.

• Community: Natural Process• Communicable Infection: Direct contact with

another infected person• Environment: Cross contamination by another

patient or an inanimate object-Fomite

Exogenous or Endogenous

• Acquired from sources outside the body or inside the body.

• Nosocomial Infection Most are related to: a. Urinary tract b. Wound Infection c. Respiratory Tract d. Venous access points

Endogenous

• Acquired from sources within the body

1. Most wound infections seed by endogenous organisms.

2. Spontaneous infection a. Appendicitis b. Cholecystitis c. Bowel perforation

What is necessary for an infection?

• Introduction of virulent microorganism• Into a receptive wound or susceptible host• May occur as a result of introduction at time

of procedure• Secondary contamination is uncommon *Fibrin seals wound with in hours

Stages of Infection

• Incubation• Prodromal• Acute• Convalescent

• ACUTE: Rapid course

• CHRONIC: Occurs over a long time a. Fungal infections b. Bone infections

Classifications of Post op Wound Infections

• Incisional infection a. At the site b. Within 30 days c. Involved skin and subcutaneous d. Area is inflamed and sore e. Purulent drainage ID culture f. Usually I & D by surgeon

• Deep Wound Infection: a. At the site b. Within 30 days c. Within 1 year of implant d. Involves tissues or spaces beneath the fascia e. Pus may be present f. May open and drain g. May remove implant

Prevention of Wound Infections• Adherence to aseptic technique, standard precautions• Control of endogenous infection• Meticulous surgical technique• Reduction of exogenous or environmental sources of

contamination• Thorough prompt cleaning and debridement of traumatic

wounds• Prevention of contamination of a wound intraoperatively• Appropriate use of prophylactic antibiotics• Frequent hand washing• Sterile technique for dressing changes

Necessities to assess a wound postoperatively

• Location• Color: Red and pink = Healing White and Yellow = Pus Black = Necrotic Red and Swollen = Infection Macerated – Better collection of drainage from wound.

• Perfusion of tissues• Size of infected area• Temperature of site and patient• Dressing conditions/Type• Drainage or drainage devise