A short infomation about surgical infection

3.  Hippocrates(c460-375 BC) he said disease are natural, he
cleaned wounds with wine or with boiled water and pus heal
naturally
 Middle age(5th-15th century)-they thought illness is
punishment of god. All wounds are expected to be infected.
After epidemics SSI were main cause of death
 17th and 18th century –disease are imbalance of humour and
pus still considered as sign of healing
 GERM THEORY-LOUIS PASTEUR(1822-1895) he found
microorganism are responsible for infection
 LISTER(1872-1912)-he found that ambient bacteria causes
infections to tissues via wounds
 KOCH(1843-1910)-bacteria can lead to infection. Clean hands
means not need of environmental disinfectants
 20th century-penicillin, antibiotics and prophylaxis, negative
pressure, non adhesive material ,routine surveillance of SSI

4.  Surgery that involves incision(cuts)
can lead to wound infection. Most
surgical wounds show up within first
30 days after operation. These
infections required surgical treatment.

5.  Performance of more complicated and
longer operation
 Increase in number of geriatric patients
 Use of implants
 Use of immunosuppressive drugs
 Laxity of aseptic techniques
 Unwarranted reliance upon antibiotic
treatment

6. 1)preoperative surgical infection
2)operative surgical infection
a)preventable
b)non-preventable
3)postoperative surgical infection

7.  Self limiting infections
 Serious infections
 Fulminant infections(fat or permanantly
disabled

8.  Primary infection-wound is the primary
site of infection
 Secondary-infection arises
complication that is not directly related
to the wound

9.  Minor-when there is discharge without
cellulitis and deep tissue destruction
 Major-when there is pus discharge with
tissue breakdown, partial or total
dehiscence of deep fascial layers of
wound and systemic illness

10. CLEAN WOUND
>1.5-5.4% infectious rate
>elective cases, primarily closed,
undrained
>nontraumatic, uninfected, no
inflammation
>no brake in asepsis
>respiratory,alimentary,genitourinary,
oropharygeal tracts or not invaded
Example= hernia repair and breast biopsy,
thyroidectomy.

11. CLEAN-CONTAMINATED WOUND
>2.1-9.5% infectious rate
>alimentary, respiratory, genitourinary
tract entered under controlled condition
or w/o unusual contamination
>minor break in technique
>mechanical drainage
Example=appendectomy,biliary tract

12. CONTAMINATED WOUND
>3.4-13.9% infectious rate
>open, fresh traumatic wounds
>entered into genitourinary or biliary in
presence of infected urine or bile
>major break in technique
Example=penetrating abdominal trauma,
enterotomy during bowel obstruction,
large tissue injury

13. DIRTY WOUND
>28-48% infectious rate
>traumatic wound with devitalized of
tissue, foreign bodies, fecal
contamination or delayed treatment
Example=transection of clean tissue for
collection of pus, peritonitis

14.  SSIs are infection tissue, organs or
spaces exposed by surgeons during
invasive procedure
 They may be
1)incisional
*superficial(limited to skin and
subcutaneous fat)
*deep incisional categories
2)organ/space infections

16.  PATIENTS FACTORS
1)Older age
2)Immunosuppression
3)Obesity
4)Diabetes melitus
5)Chronic inflammatory process
6)Malnutrition
7)Peripheral vascular disease
8)Anemia
9)Radiation
10)Chronic skin disease
11)Carrier state(chronic staplylococcus infection)
12)Recent operation
13)Transfusion
14)Nicotine and steroid usage

17.  LOCAL FACTORS
1)Poor skin preparation
2)Contamination of instruments
3)Inadequate antibiotic prophylaxis
4)Prolonged procedure
5)Local tissue necrosis
6)hypoxia, hypothermia

18.  MICROBIAL FACTORS
1)Prolonged hospitalization(nasocomial
infection)
2)Toxin secretion
3)Resistance to clearance(formation of
capsule)

19.  Increased SSI rates being associated
with HYPERGLYCEMIA

21.  SOFT TISSUE INFECTIONS
#CELLULITIS-infection of skin and
subcutaneous layer
#LYMPHANGITIS-inflammation of
lymphatic vessels
#ABSCESS-accumulation of purulent
material in dermis or subcutaneous
layer

23.  Erythema, local pain, Tenderness,
edema
 Fever, chills, malaise, toxic reactions
 Pathogens
*S.pyrogens
*S.aureus
*S.pneumoniae
*aerobic and anaerobic gram(-)

24.  Furuncle, felon, carbuncle

25.  NECROTIZING SOFT TISSUE
INFECTION
Necrotizing fascitis, gas gangrene,
streptococcal gangrene, clostridium
myonecrosis
Most commonly affected areas are-
extremitis,perineum,trunk and torso

26.  For surgical wound assessment
several scoring methods are use
#Asepsis scoring
#Southampton wound assessing scale

27.  REDNESS(rubor)
 SWELLING(tumor)
 HYPERTHERMIA(calor)
 PAIN(dolor)
 DYSFUNCTION OF ORGAN(functio
laesa)

28.  Laboratory and radiological examination
 Urinalysis, blood culture,
ultrasonography, CT scan, MRI
 Acc. To colour, odour and consistency of
pus
Foul odour-anaerobic
Greenish-P.aeruginosa
Creamy-S.aureus
Thin watery-streptococcus/clostridium

29.  Antibiotics(penicilline, cephalosporin,
erythromycin, tetracycline,
chloramphenicol, aminoglycoside,
metronidazole)
 Surgical treatment-incision and drainage
of localized abscess, removal of all
necrotized cells
 If it is in dead space-usage of sterile
close suction tubes

30.  Related to prolonged use of catheter and
tubes for purpose of urinary drainage,
ventilation, and arterial and venous
access
 UTI-treatment for 10 to 20 days with
single antibiotic. Urinary catheter is
removed as quick as possible
 MECHANICAL VENTILATOR-associated
with increased incidence of pneumonia
 Intravascular catheter-prolonged usage,
highly risk under emergency insertion
and not sterile condition

31. Call your doctor if your
surgical wound has any signs
of infection:
Pus or drainage
Bad smell coming from the wound
Fever, chills
Hot to touch
Redness
Pain or sore to touch