Surgical infections Control

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Surgical infections Control

  1. 1. SURGICAL INFECTIONS By Dr. Ahmed Mustafa
  2. 2. SURGICAL INFECTIONS <ul><li>Infections that require surgical treatment or </li></ul><ul><li>related to operative interventions </li></ul>
  3. 3. SURGICAL INFECTIONS <ul><li>Infections required surgical treatment </li></ul><ul><li>• Necrotizing soft tissue infections </li></ul><ul><li>• Infections of body cavities (peritonitis, empyema, etc.) </li></ul><ul><li>• Infections confined to an organ or tissue (abscesses, septic arthritis, cholecystitis, etc) </li></ul><ul><li>• Prosthetic device infections </li></ul>
  4. 4. SURGICAL INFECTIONS <ul><li>INFECTIONS RELATED TO OPERATIVE INTERVENTION </li></ul><ul><li>• Wound infections - Surgical site infections </li></ul><ul><li>• Postoperative infections </li></ul><ul><li>(peritonitis or other cavity infections) </li></ul><ul><li>• Surgical nosocomial infections </li></ul><ul><li>(pneumonia, urinary tract infections, catheter infections) </li></ul>
  5. 5. NOSOCOMIAL INFECTIONS <ul><li>Occurs after the initial 48 hours of admission </li></ul><ul><li>• Urinary tract infection </li></ul><ul><li>• (IV) Catheter-related infection </li></ul><ul><li>• Lower respiratory tract infection </li></ul><ul><li>• Infection via transfusion </li></ul><ul><li>• Bacteriemia and Sepsis </li></ul>
  6. 6. PATHOGENESIS <ul><li>DETERMINANTS OF INFECTIONS </li></ul><ul><li>Microorganism </li></ul><ul><li>Host Defenses </li></ul><ul><li>(virulance) (type&severity of immunosupression) </li></ul><ul><li>INFECTION Environment </li></ul><ul><li>(Fluids, foreign bodies, a closed unperfused space etc.) </li></ul>
  7. 7. Infectious agent <ul><li>The Endogenous Gastrointestinal Microflora </li></ul><ul><li>• Stomach </li></ul><ul><li>• Duodenum Aerobes and anaerobes </li></ul><ul><li>• Proximal small bowel <10 4 /mL </li></ul><ul><li>• Distal small bowel Enterobacteriaceae Enterococcus spp 10 3 -10 8 /mL Anaerobic organisms </li></ul><ul><li>• Colon Anaerobic organisms Bacteriodes fragilis 10 12 /mL </li></ul>
  8. 8. Microbiology of Intraabdominal Infections <ul><li>Aerobes: </li></ul><ul><li>Escerichia coli </li></ul><ul><li>Klebsiella spp. </li></ul><ul><li>Proteus spp </li></ul><ul><li>Enterobacter spp </li></ul><ul><li>Enterococcus spp </li></ul><ul><li>Anaerobes: </li></ul><ul><li>Bacteriodes spp </li></ul><ul><li>Peptostreptococcus spp </li></ul><ul><li>Clostridium spp </li></ul><ul><li>Bilophila wadsworthia </li></ul><ul><li>Fungi,Candida </li></ul>
  9. 9. HOST DEFENSE MECHANISMS <ul><li>Nonspecific </li></ul><ul><li>Surface Mechanical barrier </li></ul><ul><li>(skin, mucosa) Secretory barrier Immunoglobulins </li></ul><ul><li>Ciliary motion Movement </li></ul>
  10. 10. HOST DEFENSE MECHANISMS <ul><li>Specific </li></ul><ul><li>Cellular defense Phagocytic cells Cell-mediated immunity (PNLs, eosinophils, mononuclear cells) (T lymphocytes & macrophages) </li></ul><ul><li>Natural killer cells </li></ul><ul><li>Humoral defense Lyzozyme Immunoglobulins </li></ul><ul><li>Complement </li></ul><ul><li>Interferon </li></ul>
  11. 11. A Susceptible host <ul><li>Causes of Impaired Host Resistance to Infection </li></ul><ul><li>Patient ’ s Underlying Condition </li></ul><ul><li>• AIDS </li></ul><ul><li>• Remote infection </li></ul><ul><li>• Neoplasia </li></ul><ul><li>• Malnutrition </li></ul><ul><li>• Acute stress </li></ul><ul><li>(burns, trauma) </li></ul><ul><li>• Metabolic illness </li></ul><ul><li>(DM, uremia) </li></ul><ul><li>• Aging </li></ul><ul><li>• Obesity </li></ul><ul><li>• Smoking </li></ul>
  12. 12. A Susceptible host <ul><li>Iatrogenic </li></ul><ul><li>• Antineoplastic </li></ul><ul><li>chemotherapy </li></ul><ul><li>• Immunosuppressive </li></ul><ul><li>therapy </li></ul><ul><li>(allograft recipients, </li></ul><ul><li>autoimmune disorders) </li></ul><ul><li>• Splenectomy </li></ul>
  13. 13. Infection Environment <ul><li>Wound or a natural space with narrow outlets </li></ul><ul><li>Fluids, foreign bodies, a closed unperfused space etc </li></ul>
  14. 14. Clinical finding <ul><li>LOCAL MANIFESTATIONS OF SURGICAL INFECTIONS </li></ul><ul><li>• CELLULITIS: Spreading infection of the skin and subcutaneous tissue </li></ul><ul><li>• LYMPHANGITIS: Inflammation of the lymphatic channels in the subcutaneous tissue </li></ul><ul><li>• ABSCESS: Localized accumulation of purulent </li></ul><ul><li>material situated in the dermis or subcutaneous </li></ul><ul><li>tissue </li></ul>
  15. 15. SURGICAL SITE INFECTION <ul><li>The term “ surgical site infection ” now replaces “ surgical wound infection ” </li></ul><ul><li>• Superficial incisional SSI; </li></ul><ul><li>involves the skin or subcutaneous tissue </li></ul><ul><li>• Deep incisional SSI; </li></ul><ul><li>involves the deep tissue such as fascia or muscle,Organ/space SSI </li></ul>
  16. 16. SURGICAL SITE INFECTION DEFINITION <ul><li>Superficial Incisional Infection </li></ul><ul><li>Any incisional infection occuring within postoperative 30 days at any level above fascia described as; </li></ul><ul><li>• Presence of any purulant discharge (culture may not reveal any opponent) </li></ul><ul><li>• Any positive culture findings from primarily closed incision </li></ul><ul><li>• Deleberate incision exploration </li></ul><ul><li>• Infection diagnosis determined by the surgeon </li></ul>
  17. 17. SURGICAL SITE INFECTION DEFINITION <ul><li>Deep Incisional /Organ / Space Infection </li></ul><ul><li>Any infection occuring within postoperative 30 days or within postoperative one year if any implant is left </li></ul><ul><li>described as; </li></ul><ul><li>• Presence of any purulant discharge (through drains) </li></ul><ul><li>• Any positive culture findings from intraabdominal samples </li></ul><ul><li>• Spontaneous wound dehiscence </li></ul><ul><li>• Presence of abscess </li></ul><ul><li>• Infection diagnosis determined by the surgeon </li></ul>
  18. 18. Diagnosis <ul><li>• Redness </li></ul><ul><li>• Swelling </li></ul><ul><li>• Hyperthermia </li></ul><ul><li>• Fluctuation </li></ul><ul><li>• Purulent or turbid aspirate </li></ul>
  19. 19. OPERATIVE WOUNDS <ul><li>NATIONAL RESEARCH COUNCIL CLASSIFICATION OF OPERATIVE WOUNDS </li></ul>
  20. 20. CLASSIFICATION OF OPERATIVE WOUNDS <ul><li>CLEAN </li></ul><ul><li>• Nontraumatic </li></ul><ul><li>• No inflammation encountered </li></ul><ul><li>• No break in technique </li></ul><ul><li>• Respiratory, alimentary, genitourinary tracts not entered </li></ul>
  21. 21. CLASSIFICATION OF OPERATIVE WOUNDS <ul><li>CLEAN CONTAMINATED </li></ul><ul><li>• Gastrointestinal or respiratory tracts entered without significant spillage </li></ul><ul><li>• Appendectomy </li></ul><ul><li>• Oropharynx entered </li></ul><ul><li>• Vagina entered </li></ul><ul><li>• Genitourinary tract entered in absence of infected urine </li></ul><ul><li>• Biliary tract entered in absence of infected bile </li></ul><ul><li>• Minor break in technique </li></ul>
  22. 22. CLASSIFICATION OF OPERATIVE WOUNDS <ul><li>CONTAMINATED </li></ul><ul><li>• Major break in technique </li></ul><ul><li>• Gross spillage from gastrointestinal tract </li></ul><ul><li>• Traumatic wound, fresh </li></ul><ul><li>• Entrance of genitourinary or biliary tracts in presence of infected urine or bile </li></ul>
  23. 23. CLASSIFICATION OF OPERATIVE WOUNDS <ul><li>DIRTY and INFECTED </li></ul><ul><li>• Acute bacterial inflammation encountered, without pus </li></ul><ul><li>• Transection of clean tissue for the purpose of surgical access to a collection of pus </li></ul><ul><li>• Traumatic wound with retained devitalized tissue,foreign bodies, fecal contamination, and/or delayed treatment, or from dirty source. </li></ul>
  24. 24. Treatment <ul><li>Principles of Antibiotic Therapy </li></ul><ul><li>• Why to use antibiotics? </li></ul><ul><li>• Where is infection? </li></ul><ul><li>• What are the most probable pathogens? </li></ul><ul><li>• How about antibiotic susceptibility? </li></ul><ul><li>• Pharmacological properties </li></ul><ul><li>• Is combination of antibiotics necessary? </li></ul><ul><li>• Host factors </li></ul><ul><li>• Monitoring accuracy of therapy </li></ul>

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