bone infections include osteomyelitis and septic arthritis

1. BONE
INFECTIONS
OSTEOMYELITIS
SEPTIC ARTHRITIS
PREPARED BY:
PRABITA SHRESTHA

2. INTRODUCTION:
Musculoskeletal system
contamination can result
either as infection
spreads from other sites
in the body or from
external insults (e.g.:
puncture, surgery).
Infections are often
severe and difficult to
treat because the bones
are relatively
inaccessible to protective
macrophages and
antibodies.

3. Contd…
Even a small number of microorganisms
can be enough to establish a serious
infection that can lead to loss of function
or even death.
For this reason, nurses should be diligent
in wound care and alert to any
manifestations that suggest infection.

4. Osteomyelitis
Osteomyelitis is an
infection of bone by
direct or indirect
invasion of an
organism.
Although generally
bacterial in origin,
osteomyelitis can also
be caused by a virus
or fungus.

5. Types of osteomyelitis:
On the basis of mode of entry of the
pathogen; it is divided into two types:
1.Exogenous osteomyelitis
2.Haematogenous osteomyelitis

6. 1. Exogenous osteomyelitis
 Exogenous osteomyelitis is secondary to a
contagious source of infection, is caused by a
pathogen from outside the body.
 E.g. pathogens from an open fracture or surgical
procedure, involving instrumentation.
 This spreads from soft tissues to bone.

7. 2.Haematogenous osteomyelitis
 It is caused by blood-borne pathogen
originating from infectious site within the
body.
 E.g. sinus, ear, dental, respiratory and
genitourinary infections.
 It spreads from bone to soft tissues and can
even break through the skin, becoming a
draining fistula.

9. Causative agents:
 Staphylococcus aureus (most common)
 Pseudomonas
 Klebsiella
 Salmonella
 Escherichia coli
 Pneumococcus species
 Proteus vulgaris
 Pasteurella multicida

10. Causes:
 Human and animal bites
 Open fracture
 Surgical procedure, involving instrumentation
 Other infections like sinus, ear, dental,
respiratory and genitourinary
 Minor traumatic disorder
 Acute infection originating elsewhere in the
body

11. Risk factors:
 Chronic illness
 Diabetes mellitus
 Alcohol/drug abuse
 Immunosuppression

13. Clinical manifestations:
Symptoms vary in adult and children according to
the site of involvement.
 Sudden pain and tenderness in the affected bone
 Localized pain and drainage
 Swelling, restricted movement of surrounding
soft tissues
 Chronic infection presenting intermittently for
years, flaring after minor trauma or persisting as
drainage of pus from a pocket in a sinus tract
 Tachycardia
 Fever

14. Contd…
 Chills
 Nausea
 Malaise
 Dysphagia
 Dyspnea
 Decreased oesophageal motility

15. Investigations:
 Acute osteomyelitis diagnosis made on initial clinical signs
(history, physical examination, CBC, erythrocyte
sedimentation rate {ESR})
 Aerobic and anaerobic cultures of bone and tissue to identify
the organism
 ESR elevated, WBC and hemoglobin decreased
 Radiographic evidence of osteomyelitis lags behind
symptoms by 7-10 days
 Plain film evidence of infection 3-4 weeks later.
 Bone necrosis seen 10-14 days on X-ray
 Radionuclide bone scans used to diagnose early acute
osteomyelitis.
 MRI used increasingly- distinguishes between soft tissue and
bone marrow.

17. Treatment:
Use of treatment modality is used depends on the
area of bone involved.
 Antibiotic therapy: IV antibiotics may be
prescribed for up to 6 weeks and oral antibiotics
therapy may continue for up to 6 months. E.g. :
ciprofloxacin and ofloxacin.
 Analgesics and antipyretics as necessary.
 Hyperbaric O2 therapy may be used as an
adjunctive therapy.

18.  Irrigation and drainage systems : This involves a
surgical procedure in which holes are drilled into
the cortex of bone, allowing continuous infusion
of antibiotic solution and drainage of
inflammatory exudate. Drains are usually
removed after a few days to prevent secondary
infection.

19. Complications:
 Non-healing wound
 Sepsis
 Immobility
 amputation

20. Nursing management:

21. Nursing assessment
 Obtain detailed history of injury
 Assess pain and functional deficits
 Be aware that systemic symptoms are acute in
children but vary in intensity with adults
 Perform general systemic assessment because
adults with long bone involvement generally have
more systemic septic symptoms.

22. Nursing diagnosis:
 Acute/chronic pain related to inflammatory
process.
 Impaired physical mobility related to rest of
affected part.
 Risk for extension of infection: bone abscess
formation.

23. Nursing interventions:
 Relieving pain:
1. Administer opiods for acute pain; non-narcotics
for chronic pain.
2. Administer medications around the clock versus
as necessary to establish a consistent blood
level.
3. Report any decreased in pain that may indicate
worsening infection.

24. Contd….
 Increasing physical mobility:
1.Treatment regimens restrict activity. The bone is
weakened by the infective process and must be
protected by immobilization devices and by
avoidance of stress on the bone.
2.The patient must understand the rationale for the
activity restrictions. The joints above and below
the affected part should be gently moved through
their range of motion. The nurse encourages full
participation in ADLs within the physical
limitations to promote general well being.

25.  Increasing knowledge:
1. Describe the infectious process and rationale for
prolonged treatment with osteomyelitis.
2. Explain IV antibiotic therapy, potential adverse
effects, and reactions.
3. Explain strict adherence to infection control
practices ( sterile technique, hand washing) to
prevent spread of infection in some cases.
Contd….

26.  Promoting rest without complication:
1. Support the affected extremity to minimize
pain.
2. If patient is on bed rest, prevent hazards of
immobility (passive ROM, position change,
coughing and deep breathing exercises)
3. Encourage distraction activities.
Contd….

27.  Patient education and health maintenance:
1. Advise patient to adhere to infection control
principles- proper hand washing, disposal of
wound drainage, dressings to prevent
reinfection/transmission of infection at home.
2. Stress adherence to medication regimen, which
may be prolonged, with frequent follow up visits.
3. Teach care of indwelling device for medication
delivery (such as Hickman catheter)
Contd….

28. Expected outcomes:
 Pain managed with non-narcotic analgesics.
 Infectious process minimized.
 Functional status of affected joint intact.