13. Infection Environment
• Wound or a natural space with narrow
outlets
• Fluids, foreign bodies, a closed unperfused
space etc
14. Clinical finding
• LOCAL MANIFESTATIONS OF SURGICAL INFECTIONS
• • CELLULITIS: Spreading infection of the skin and
subcutaneous tissue
• • LYMPHANGITIS: Inflammation of the lymphatic channels in
the subcutaneous tissue
• • ABSCESS: Localized accumulation of purulent
material situated in the dermis or subcutaneous
tissue
15. SURGICAL SITE INFECTION
• The term “surgical site infection” now replaces
“surgical wound infection”
• • Superficial incisional SSI;
involves the skin or subcutaneous tissue
• • Deep incisional SSI;
involves the deep tissue such as fascia or
muscle,Organ/space SSI
16. SURGICAL SITE INFECTION
DEFINITION
• Superficial Incisional Infection
• Any incisional infection occuring within postoperative 30
days at any level above fascia described as;
• • Presence of any purulant discharge (culture may not reveal
any opponent)
• • Any positive culture findings from primarily closed incision
• • Deleberate incision exploration
• • Infection diagnosis determined by the surgeon
17. SURGICAL SITE INFECTION
DEFINITION
• Deep Incisional /Organ / Space Infection
• Any infection occuring within postoperative 30 days or
within postoperative one year if any implant is left
• described as;
• • Presence of any purulant discharge (through drains)
• • Any positive culture findings from intraabdominal
samples
• • Spontaneous wound dehiscence
• • Presence of abscess
• • Infection diagnosis determined by the surgeon
20. CLASSIFICATION OF OPERATIVE WOUNDS
• CLEAN
• • Nontraumatic
• • No inflammation encountered
• • No break in technique
• • Respiratory, alimentary, genitourinary tracts
not entered
21. CLASSIFICATION OF OPERATIVE WOUNDS
• CLEAN CONTAMINATED
• • Gastrointestinal or respiratory tracts entered without
significant spillage
• • Appendectomy
• • Oropharynx entered
• • Vagina entered
• • Genitourinary tract entered in absence of infected urine
• • Biliary tract entered in absence of infected bile
• • Minor break in technique
22. CLASSIFICATION OF OPERATIVE WOUNDS
• CONTAMINATED
• • Major break in technique
• • Gross spillage from gastrointestinal tract
• • Traumatic wound, fresh
• • Entrance of genitourinary or biliary tracts in
presence of infected urine or bile
23. CLASSIFICATION OF OPERATIVE WOUNDS
• DIRTY and INFECTED
• • Acute bacterial inflammation
encountered, without pus
• • Transection of clean tissue for the purpose of
surgical access to a collection of pus
• • Traumatic wound with retained devitalized
tissue,foreign bodies, fecal contamination, and/or
delayed treatment, or from dirty source.
24. Treatment
• Principles of Antibiotic Therapy
• • Why to use antibiotics?
• • Where is infection?
• • What are the most probable pathogens?
• • How about antibiotic susceptibility?
• • Pharmacological properties
• • Is combination of antibiotics necessary?
• • Host factors
• • Monitoring accuracy of therapy