Upload
sujith-jose
View
215
Download
1
Embed Size (px)
Citation preview
Introduction toSurgical Site Infections
Dr.Sujith Mathew JosePG in General Surgery
Coimbatore Medical College Coimbatore
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
Galen recognised locatisation of infection (=suppuration ) in gladiatorial wound
Ambroise Pare observed clean wounds closed primarily heal without infection
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
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
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
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
What is SSI?
Infections that occur in the wound created by an
invasive surgical procedure are
generally referred to as surgical site
infections
Criteria for defining SSIs
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
• SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related to SSI
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
These endotoxins are lipopolysaccharides in bacterial cell wall
They activate macrophages to release proinflammatory cytokines
Cytokines finally leads to MODS and SIRS
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.
• 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).
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
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
thankyou