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Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
Ephrem surgical-infections-talk
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Ephrem surgical-infections-talk

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  • 1. Surgical Infections MS-3 Surgery Clerkship Lecture Natalia Hannan M.D. 07/05/11
  • 2. Ignaz Semmelweis 1847 Realized that washing hand with a chlorinated lime solution decreased incidence of newborn death from “puerperal fever’.
  • 3. Joseph Lister • 1883-1897 • British surgeon • Used Carbolic Acid (Phenol) to clean hands, instruments and wipe on surgical wounds drastically decreased infections.
  • 4. Overview • Recognizing Infection • Soft Tissue Infections • Post-operative Infections – Surgical Site Infection – Hospital Acquired Infections • Antibiotic Prophylaxis • Blood Born Pathogens
  • 5. Infection Infection is defined by: 1. Microorganisms in host tissue or the bloodstream 2. Inflammatory response to their presence.
  • 6. Inflammatory Response Localized: – Rubor, Calor, Dolor, Tumor, and functio laesa (loss of function) Systemic: – Systemic Inflammatory Response Syndrome (SIRS)
  • 7. S.I.R.S. Any Two of the Following Criteria 1. Temperature: < 36.0, >38.0 2. Heart Rate : >90 3. Respiratory Rate: >20 4. WBC: <4,000, >12,000
  • 8. Sepsis Definition: SIRS plus evidence of local or systemic infection. Septic Shock Definition: Sepsis plus end organ hypoprofusion. Mortality of up to 40%
  • 9. Soft Tissue Infections: 1. Cellulitis 2. Abscess 3. Necrotizing Infections
  • 10. Cellulitis
  • 11. Cellulitis Definition: Diffuse infection with severe inflammation of dermal and subcutaneous layers of the skin Diagnosis: Pain, Warmth, Hyperesthesia Treatment: Antibiotics. Common Pathogens: Skin Flora (Streptococcus/Staphylococcus)
  • 12. Abscess
  • 13. Abscess Definition: Infectious accumulation of purulent material (Neutrophils) in a closed cavity Diagnosis: Fluctuant: Moveable and compressible Treatment: Drainage
  • 14. Necrotizing Soft Tissue Infection
  • 15. Necrotizing Soft Tissue Infection Definition: Deep infection of skin and soft tissue that may spread rapidly along facial planes. Diagnosis: Purely Clinical, dishwater discharge, gray tissue, pain out of proportion to examination, bulla, and dark, golden discoloration. Treatment: True Surgical Emergency, Antibiotics
  • 16. Necrotizing Soft Tissue Infection • Common Pathogens – Clostridium – Group A streptococcus – Polymicrobial • Toxic Shock Syndrome – Streptococcus – Staphylococcus
  • 17. Post-Operative Infections • Fever After Surgery • The “Five W’s” – Wind: Atelectisis – Water: UTI – Walking: DVT – Wonder Drug: Medication Induced – Wound: Surgical Site Infection
  • 18. Surgical Site Infections • 3rd most common hospital infection • Incisional – Superficial – Deep • Organ Space – Generalized (peritonitis) – Abscess
  • 19. Types of Surgery Clean Hernia repair breast biopsy 1.5% Clean- Contaminated Cholecystectomy planned bowel resection 2-5% Contaminated Non-preped bowel resection 5-30% Dirty/infected perforation, abscess 5-30%
  • 20. Host Risk Factors • Diabetes mellitus • Hypoxemia • Hypothermia • Leukopenia • Nicotine (tobacco smoking) • Immunosuppression • Malnutrition • Poor skin hygiene
  • 21. Perioperative Risk Factors • Operative site shaving • Breaks in operative sterile technique • Improper antimicrobial prophylaxis • Prolonged hypotension • Contaminated operating room • Poor wound care postoperatively • Hyperglycemia • Wound closure technique
  • 22. Treatment • Incisional: open surgical wound, antibiotics for cellulitis or sepsis • Deep/Organ space: Source control, antibiotics for sepsis
  • 23. Operative Antibiotic Prophylaxis • Decreases bacterial counts at surgical site • Given within 30 minutes prior to starting surgery • Vancomycin 1-2 hours prior to surgery • Redose for longer surgery • Do not continue beyond 24 hours
  • 24. Other Hospital Acquired Infections 1. Urinary Tract Infection 2. Indwelling Catheter Infection 3. Pneumonia
  • 25. Use/Choice of Antibiotics • Use only when indicated • Start with broad spectrum antibiotics designed to cover likely pathogens • Take cultures when possible • Deescalate spectrum once pathogen is know • Have a plan for duration
  • 26. Occupational Blood Bourne Virus Infections HBV HCV HIV Risk from Needle stick 30% 2% 0.3% Chemoprophylaxis Yes No Yes Vaccine Yes No No

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