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Flashcards in Peri operative infection Deck (26)
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1
Q

What is a surgical site infection?

A

A type of hospital aquired infection

2
Q

What are the 3 categories of SSI?

A
Superficial incisional ( skin and subcutaneous tissue)
Deep insisional (Fascial/muscle layer)
Organ/space infection ( anything other than above)
3
Q

What is the perioperative period?

A

pre-med to recovery

4
Q

What are the disadvantages of a SSI?

A
Delayed healing 
Poor cosmesis
Increased medical costs 
possible revision surgery 
client relationships 
patient welfare 
increased anti biotic use
5
Q

What is the most common cultured bacteria from SSI?

A

Staphlococci

6
Q

What is a Biofilm?

A

Bacteria which attach to a surface in large numbers or communities enabling them to adapt to their environment.

7
Q

What are the characteristics of a biofilm?

A

Resistant
Quiescent state ( negative on culture)
Suspect if patient infected or re-infection occurs after treatment

8
Q

How is an infected patient treated?

A
Barrier nursed
AB based on culture and sensitivity 
Strict aseptic wound management
Debridement of necrotic tissue 
covering of the wound
Record presence of bacteria when it was isolated, how it was treated, whether treatment was successful
9
Q

What is an Exogenous micro-organism?

A

A source outside the patient (surgeon, equipment)

10
Q

What is a Endogenous micro-organism?

A

A source of infection from within the patient

patient skin flora

11
Q

What are the 3 categories of factors that may predispose a patient to infection?

A

Patient
Environment
Treatment

12
Q

Why is compliance important to prevent infection?

A

Scrub protocols
antimicrobial propylaxis
Hand hygiene
aseptic

13
Q

List the patient factors the pre-dispose them to infection?

A

Body condition (malnutrition decreased albumin levels)
Age ( over 10 poor immune system below 1 under developed immune system)
Immunosupressed (diabetes mellitus, steriods, endocrinopathies)
Bacteria already within the blood
Skin disease
Recent operation (suture material)
Prior site radiation
Perioperative temperature (Vasoconstriction, shivering increases o2 consumption)

14
Q

What are the environmental factors that pre-dispose a patient to infection?

A
Patient preparation 
Cross contamination (Handwashing)
Aseptic technique 
Theatre conduct(personnel, attire) 
Cleaning methods (damp dusting lamps, disinfectant)
Inadequate ventilation
15
Q

What are the treatment factors that pre-dispose a patient to infection?

A
Surgical time (infection rate doubles with every hour) 
Experience (halsteads principles) 
Inadequate antibiotic
Drains 
Emergency procedure 
surgical implants
suture material
16
Q

When should you wash your hands?

A
Before and after touching a patient 
Before and after touching surroundings 
Before carrying out aseptic tasks 
before and after gloving 
after exposure to contaminated tissue/fluids
17
Q

What steps should be followed when hand washing?

A

WHO 6 steps

18
Q

What are the Halstead principles?

A
Gentle handling of tissue 
adequate haemostasis
preservation of blood supply
strict aseptic technique
minimum tension at wound closure 
good tissue approximation 
obliteration of dead space
19
Q

What are the four classifications of surgery?

A

Clean (Non traumatic surgical wounds, spay, ortho, wounds that do not involve GI genitourinary or oropharynegeal)
Clean-contaminated (entering GI, genitourinary, or oropharyngeal tracts controlled condition)
Contaminated (spillage of contents entering the above tracts)
Dirty (old purulent wound, foreign body, faecal material)

20
Q

What will help minimise infection during surgery?

A

Lavage
debridement
Antibiotics
wound swab

21
Q

What are the infection rates for clean
clean contaminated
contaminated and
dirty wounds?

A

Clean 0.4-4%
Clean contaminated 4.5-9.3%
Contaminated 5.8-28.6%

22
Q

When should an antibiotic be used?

A

Surgical implants
surgery over 90 minutes
clean contaminated, contaminated, dirty procedures

23
Q

How is the selection of AB made?

A

Most likely bacterial contaminant, staphyloccocus of ecoli

Culture results

24
Q

When should antibiotics be administered?

A

So they are effective at the time of surgery 30-1 hour prior to surgery
Discontinued withing 24 hours of completion of clean surgeries

25
Q

How should you care for a surgical wound after surgery?

A

Apply sterile dressing 24-48 hours after surgery
Patient interferance
remove drains asap
(cover stomat of active drains, cover exit site of penrose drain)
strict hygiene
nutrition (protein needed for good wound healing)
monitor

26
Q

How should you carry out a clinical audit?

A

Record any infections or complications during surgery
identify problem area
review
implement changes (ensure evidence based)
audit and review changes regularly