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Introduction to Surgical Site Infections Dr.Sujith Mathew Jose PG in General Surgery Coimbatore Medical College Coimbatore

introduction of surgical site infections

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Page 1: introduction of surgical site infections

Introduction toSurgical Site Infections

Dr.Sujith Mathew JosePG in General Surgery

Coimbatore Medical College Coimbatore

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History

First concept of infection and methods to prevent it can be traced back to Egyptians by there mummification skills

HIPPOCRATES, The Father of Medicine used Wine and vinegar to irrigate open infected wound

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Galen recognised locatisation of infection (=suppuration ) in gladiatorial wound

Ambroise Pare observed clean wounds closed primarily heal without infection

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Austrian obstetrician Ignac Semmelweis showed that SIMPLE ACT OF HAND WASHING between cases decreased puerperal sepsis

Sir Joseph Lister, applied Louis Pasteur’s idea of microbiology to promote the idea of antiseptic surgery

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Koch’s Postulates

An infective Organism• Must be found in considerable

number in septic focus• Must be cultured in pure form

from septic focus• Must be able to produce similar

lesions when injected into another host

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Wound infection depends on

• Host Response• Virulence of the agent• Vascularity and health of tissue involved• Presence of dead or foreign tissue• Use of antibiotics

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Intact epithelial surface prevents the entry of microorganisms

SKIN IS THE BEST BARRIER TO ENTRY OF PATHOGEN

These are broken down inTraumaSurgery

Other protective mechanisms areChemical- low gastric pHHumoral - antibodies, complimentsCellular - phagocytes and macrophages

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What is SSI?

Infections that occur in the wound created by an

invasive surgical procedure are

generally referred to as surgical site

infections

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Criteria for defining SSIs

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SSI is MOST COMMON hospital acquired infection in surgical patients.

3rd most common hospital acquired infection.

Preventable

Prolong the hospital stay (7.3 days)

Expenditure

Over one-third of postoperative deaths

Poor scar, persistent pain and itching, restriction of movement and a significant impact on emotional wellbeing

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• SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related to SSI

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During perioperative period,When the enteral feeding is suspendedBacterial (mainly gram negative bacteria) colonise normal sterile upper GIT

Then they translocate to mesentric lymphnodes and release endotoxins

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These endotoxins are lipopolysaccharides in bacterial cell wall

They activate macrophages to release proinflammatory cytokines

Cytokines finally leads to MODS and SIRS

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The wound healing process

• The ‘normal’ wound healing process has been identified as involving three overlapping major phases:– Inflammation, early (first 24 hours) and late

phases (normally up to 72 hours)– Regeneration– Maturation.

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• The key cells that are involved in this process have been identified as:

– inflammation – platelets, neutrophils, lymphocytes and macrophages

– regeneration and maturation – macrophages and fibroblasts, the latter of which are linked with the deposition and regulation of collagen as well as wound contraction (myofibroblasts).

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Microbiology of SSI

• Nature of the Procedure

• Location of the incision

• Whether hollow viscus entered

GRAM POSITIVESStaph Epidermidis

Staph AureusEnterococcus Species

GRAM NEGATIVESE Coli

Klebsella

PHARYNXLOWER GIT

FEMALE GENITAL TRACT

ANAEROBES

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After a breach in the epithelial surface,Acute inflammatory response take up to 4

HOURS to get mobilised

DECISIVE PERIOD

Prophylactic antibiotics should cover this period

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thankyou