A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
Preventing Infection during Surgery is important. Standard Guidelines help team work on the same page. An update on various preventive strategy is discussed.
Surgical site Infection during Internship in medical college.pptxrautkrisna
Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between 814 and 6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wllbeing
Preventing Infection during Surgery is important. Standard Guidelines help team work on the same page. An update on various preventive strategy is discussed.
Surgical site Infection during Internship in medical college.pptxrautkrisna
Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between 814 and 6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wllbeing
Pathogenic microorganisms proliferate and invade bodily tissue, causing tissue harm and disease.
The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites those are not normally present within the body.
An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent.
An infection may remain localized, or it may spread through the blood or lymphatic vessels to become systemic (body wide).
Microorganisms that live naturally in the body are not considered infections.
For example, bacteria that normally live within the mouth and intestine are not infections.
Infection prevention policies and practices are used in hospitals and other health care facilities to reduce the spread of infections.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
2. Surgical Infections
Introduction
Surgical infections may arise in the surgical
wound itself or in other systems in the
patient.
They can be initiated not only by “damage”
to the host but also by changes in the
host’s physiologic state.
3. 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
14. What is a
Surgical Site Infection?
SSI’s can be defined as an infection that is present up to 30 days after a
surgical procedure if no implants are placed, and up to one year if an
implantable device was placed in the patient
The majority of SSIs will occur during the first 2-3 weeks after surgery
38% of all nosocomial (hosp. acquired) infections in surgical patients are SSI
2 to 5% of operated patients will develop a SSI
16. Some definitions
Colonization:
presence of bacteria in a wound with no signs or
symptoms of systemic inflammation . usually bacterial
count less than 10*5cfu/ml
Contamination:
Transient exposure of a wound to bacteria.
Varying concentration of bacteria possible.
Time of exposure less than 6 hours.
SSI prophylaxis is best strategy.
Infection:
systemic and local signs of inflammation,
bacterial count more than 10*5cfu/ml
17. Types of Surgical Site Infections
According to the tissue involved:
1. Superficial
2. Deep incisional
3. Organ/space
18. A superficial incisional SSI must meet one of the
following criteria:
Infection occurs within 30 days after the operative procedure
and
involves only skin and subcutaneous tissue of the incision
and
patient has at least one of the following:
a. purulent drainage from the superficial incision.
b. organisms isolated from an aseptically obtained culture of fluid
or tissue from the superficial incision.
c. at least one of the following signs or symptoms of infection:
pain or tenderness, localized swelling, redness, or heat, and
superficial incision are deliberately opened by surgeon, and are
culture-positive or not cultured. A culture-negative finding does
not meet this criterion.
d. diagnosis of superficial incisional SSI by the surgeon or
attending physician.
19. A deep incisional SSI must meet one of
the following criteria:
Infection occurs within 30 days after the operative procedure if no
implant is left in place or within one year if implant is in place and the
infection appears to be related to the operative procedure
and
involves deep soft tissues (e.g., fascial and muscle layers) of the
incision
and
patient has at least one of the following:
a. purulent drainage from the deep incision but not from the organ/space
component of the surgical site
b. a deep incision spontaneously dehisces or is deliberately opened by a
surgeon and is culture-positive or not cultured and the patient has at least
one of the following signs or symptoms: fever (>38°C), or localized pain or
tenderness. A culture-negative finding does not meet this criterion.
c. an abscess or other evidence of infection involving the deep incision is found
on direct examination, during reoperation, or by histopathologic or radiologic
examination
d. diagnosis of a deep incisional SSI by a surgeon or attending physician.
20. An organ/space SSI must meet one of the
following criteria:
Infection occurs within 30 days after the operative procedure if no
implant is left in place or within one year if implant is in place and
the infection appears to be related to the operative procedure
infection involves any part of the body, excluding the skin incision,
fascia, or muscle layers, that is opened or manipulated during the
operative procedure
and
patient has at least one of the following:
a. purulent drainage from a drain that is placed through a stab wound into
the organ/space
b. organisms isolated from an aseptically obtained culture of fluid or tissue
in the organ/space
c. an abscess or other evidence of infection involving the organ/space that
is found on direct examination, during reoperation, or by
histopathologic or radiologic examination
d. diagnosis of an organ/space SSI by a surgeon or attending physician.
21. Further classifications
According to the etiology
Primary SSI :the wound is the primary site for infection
Secondary SSI :infection arise following a complication that is not
directly related to the wound
According to the time
Early with in 30 days
Intermediate 1-3 months
Late more than 3 months
According to Severity
Minor SSI :discharge without cellulites or deep tissue destruction
Major SSI :pus discharge with tissue breakdown, partial or total
dehiscence or systemic illness
22. Source of SSI Pathogens
1. Endogenous flora of the patient
2. Operating theater environment
3. Hospital personnel (doctors/nurses/staff)
4. Seeding of the operative site from distant focus of infection
(prosthetic device, implants)
23. Pathogenesis of SSI
Relationship equationDose of bacterial contamination
x Virulence Resistance of host
SSI RISK
24. Risk factors
1. surgical factors
A. Type of procedure
B. Degree of contamination
C. Duration of operation
D. Urgency of operation
2. patient-specific factors. Patient-specific factors can be further defined as either
local
High bacterial load
Wound hematoma
Necrotic tissue
Foreign body
Obesity
systemic
• Advanced age
• Shock
• Diabetes
• Malnutrition
• Alcoholism
• Steroids
• Chemotherapy
• Immuno-compromise
25. Wound Classification
according to the degree of contamination
Wound class Definition Example Infection
rate (%)
Clean Nontraumatic, elective
surgery. GI tract,
respiratory tract, GU tract
not entered
Mastectomy
Vascular
Hernias
2%
Clean
-
contaminated
Respiratory, GI, GU tract
entered with minimal
contamination
Gastrectomy
Hysterectomy
< 10%
Contaminated Open, fresh, traumatic
wounds, uncontrolled
spillage, minor break in
sterile technique
Rupture appy
Emergent
bowel resect.
20%
Dirty Open, traumatic, dirty
wounds; traumatic
perforation of hollow
viscus, frank pus
in the
field
Intestinal
fistula
resection
28-70%
26. Determinants of the infection
Every surgical site is contaminated by bacteria at the end of the
procedure, few become clinically infected.
Four important determinants lead to either uneventful wound
healing or SSI.
1. Inoculums of the bacteria
2. Virulence of the bacteria
3. Effects of microenvironment
4. Integrity of host defenses (Innate and acquired )
27. 1. Inoculum of the bacteria
Sources:
Air in operation room
Instruments
Surgeons and staff
Patient’s flora. Largest inoculum is from areas that are
heavily colonized e.g. bowel, female GUT, diseased
biliary tract
This factor is modifiable
28. 2. Virulence of the bacteria
The more virulence the bacteria, the
greater probability of infection
Coagulase positive staph
Virulent strain of perfiringens and group A streptococi
E coli
Bacteroids
This factor can not easily be controlled by preventive
strategies because it is intrinsic to the procedural site and
the type of bacteria that already colonize the patient
29. 3. Effects of microenvironment
The following factors in the microenviroment of the wound
predispose to SSI
Necrotic tissue
Hb at the surgical site
FB, drains
Dead space with in the surgical site
Surgical techniques
31. Prevention of SSI
1. Preoperative planning
2. Intra operative technique
3. Preventive antibiotic therapy
4. Enhancement of host defense
32. 1. Preoperative planning
Control preexisting infection of patient
Postpone the operation if open skin wound or hand infection
of surgeon present
Decrease preoperative hospitalization period
Shower and scrub the surgical site with antiseptic soap the
evening prior to operation
Clipping the hair from surgical site before the operation
33. 2. Intra operative technique
Skin preparation
Caps, masks gowns, surgical
gloves
Sterilization of the instruments
Gentle handling of tissue
Good haemostasis
Avoid dead space
Insert drains through separate
stab incision
Leave skin and subcutaneous
tissue open if dirty
Sterile dressing
Topical ointments
34. 3. Preventive antibiotic therapy
4. Enhancement of host defense
1. Increase oxygen delivery
2. Optimizing core body temperature
3. Blood glucose control
4. Correct any coexisting condition e.g malnutrition,
anemia……
