Surgical infections part1

1. Dr Hamid Rahman Sabawoon 1

2. Prepared and presented by: Dr Hamid
Rahman Sabawoon, MD, LMIH,MN,
Supervised by: Dr Mirwais Jalal, MD,
Trainer of G.Surgery
‫افغانســــــــتان‬ ‫اســـــــالمی‬ ‫جمــــــــــهوری‬
‫عـــــــــــــــامه‬ ‫صحـــــت‬ ‫وزارت‬
‫تخــــصـــــص‬ ‫اکمــــــــــال‬ ‫ریاســــت‬
‫بلــــــخی‬ ‫رابعـــــــه‬ ‫کمپــــلکس‬ ‫شفـــــاخانه‬
‫عمــــــومی‬ ‫جــــــراحی‬ ‫دیپــــــارتمنـــت‬

3. Surgical Infection

4. History
 Joseph Lister,
 Louis Pasteur,
 Ignaz Semmelweis,
 Theodor Kocher
 William S. Halsted,
 Application of antiseptic practices
allowed infection rate of operation to
drop from 90% to 10%.

5. Joseph Lister
 1883-1897
 British surgeon
 Used Carbolic Acid
(Phenol) to clean
hands, instruments
and wipe on surgical
wounds drastically
decreased infections.
 father of modern
surgery

6. Ignaz Semmelweis
1818-1865 (47)
Hungury,obs&gen surgery
Realized that washing
hand with a chlorinated
lime solution decreased
incidence of newborn
death from “puerperal
fever’. (saviour of
mothers)

7. Theodor kocher
1841-1917
Introduction and
promotion of aseptic
surgery &scientific
methods in surgery.
mortality rate below 1%
Noble prize 1907.
Father of thyroidectomies

8. William S. Halsted
1852-1922
Inventing the residency
training system.
Aseptic surgery.wound
closer, sterility,accurate
dissection,
Mastectomy(radical cncr)
Introducted rubber
surgical gloves.
early champion of newly
discovered anesthetics

9. Louis Pasteur
(1822-1895)
He showed that food spoils
because of microorganisms
and invented
pasteurization.
vaccination, microbial
fermentation and
pasteurization
Vaccine or rabies and anthrax
germ theory of disease

10. History
 Antibiotics: introduced in the middle of 20th
century
 Hope serious surgical infection eliminated,
but this did not occur.
 Nosocomial infection, widespread antibiotics
therapy
 New techniques: endoprosthesis,
transplantation requires immunosuppressive
agents, et al.

11. Surgical Infections
Introduction
 Surgical infections may arise in the surgical
wound itself or in other systems in the patient.
 Caused by the invasion, resident and
proliferation of pathogens, such as bacteria,
viruses and fungi et al.

12. Surgical Infections
Two main types
1. Community-Acquired
Are active process that were initiated before the patient
presented for treatment.
2. Hospital-Acquired
All infections that occur after surgical procedures

13. Community-Acquired
 Skin/soft tissue
 Cellulitis: Group A strep
 Abcess/furuncle: Staph aureus
 Necrotizing: Mixed
 Hiradenitis suppurativa: Staph
aureus
 Lymphangitis: Staph aureus
 Gangrene : synergistic
 Tetanus
 Hand infections
 Foot infections
 Biliary tract
infections
 Peritonitis
 Viral infections

14. Hospital-Acquired
 SSI (Wound infection)
 Pulmonary
 Urinary Tract
 Intra-abdominal
 Empyema
 Foreign-body associated
 Fungal infection
 Multiple organ failure

15. Classification:
Pathogenesis:
Non-specific infection: suppurative infection
Presentation: redness, swelling, hot, soreness
Pathogens: Staphylococci aureus, Streptococci.
Specific infection: tuberculosis, tetanus, gas gangrene,
fungi

16. Classification
Procession:
Acute
Subacute
Chronic
Types Severity of symptoms Duration of symptoms
Acute Severe Hours to days
Subacute Moderate Days to weeks
Chronic Mild Weeks to months

17. Classification
Source of pathogens:
Primary
Secondary
Exogenous
Endogenous

18. Classification
Opportunity:
 Opportunistic
 Superinfection
 Nosocomial infection

19. Etiology
Causes of surgical infection:
normal bacterial flora pathogenic bacteria
exogenous bacteria
low host resistance

20. Etiology
Bacteria factors:
Adherence
Toxins: exotoxin, endotoxin
numbers of bacteria: 105

21. Etiology
Local factors:
Injury of skin or mucosa
Duct obstruction
Blood supply
Skin or mucosa diseases

22. Etiology
Systemic factors:
 Severe disease
 Hormone
 Malnutrition
 AIDS

23. Pathology
 Non-specific infection:
 Bacteria proliferation
 Leucocyte infiltration
 Inflammatory media and cytokines release
 Congestion, exudation
 Accumulation of serum, blood cells, necrotic
tissues
 redness, swelling, hot and soreness, and
dysfunction.

25. Pathology
 results:
alleviate
suppurative
to spread
to be chronic

26. Pathology
 Specific infection:
Tuberculosis
Tetanus
Gas gangrene
Tungi infection

27. Diagnosis
 Clinical presentation:
Systemic condition
Local condition
Organic-systemic dysfunction
Specific expression
 Investigation:
experiment tests
imaging: US, X-ray,CT, MRI

28. Management
 Local treatment:
 protect infection site
 superficial lesion
 deep lesion
 Antibiotics:

29. Management
 Improve systemic conditions:
Hydro-electrolyte,
Nutrition
Companion diseases

30.  Bacteremia: presence of bacteria in the blood
 Pyeamia: presence of infected emboli in the blood
resulting in the formation of multiple abscesses in
various parts of the body.
 Toxemia: presence of bacterial toxins in the blood
and affecting almost every organ or tissue of the
body.
 Septicemia: pyeamia and toxemia in combination
Specific terms