This document summarizes surgical infections and their prevention. It discusses how Ignaz Semmelweis and Joseph Lister pioneered hand washing and antisepsis, decreasing surgical infection rates. Types of infections covered include soft tissue infections like cellulitis, abscesses, and necrotizing fasciitis. Post-operative infections like surgical site infections are common, and prophylactic antibiotics can lower risk. Bloodborne pathogens from occupational exposures are also addressed.

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.

7. Inflammatory Response
Localized:
– Rubor, Calor, Dolor, Tumor, and functio
laesa (loss of function)
Systemic:
– Systemic Inflammatory Response Syndrome
(SIRS)

8. 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

9. Sepsis
Definition: SIRS plus evidence of local
or systemic infection.
Septic Shock
Definition: Sepsis plus end organ
hypoprofusion. Mortality of up to
40%

10. Soft Tissue Infections:
1. Cellulitis
2. Abscess
3. Necrotizing Infections

11. Cellulitis

12. 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)

13. Abscess

14. Abscess
Definition: Infectious accumulation of
purulent material (Neutrophils) in a
closed cavity
Diagnosis: Fluctuant: Moveable and
compressible
Treatment: Drainage

15. Necrotizing Soft Tissue
Infection

16. 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

17. Necrotizing Soft Tissue
Infection
• Common Pathogens
– Clostridium
– Group A streptococcus
– Polymicrobial
• Toxic Shock Syndrome
– Streptococcus
– Staphylococcus

18. Post-Operative Infections
• Fever After Surgery
• The “Five W’s”
– Wind: Atelectisis
– Water: UTI
– Walking: DVT
– Wonder Drug: Medication Induced
– Wound: Surgical Site Infection

19. Surgical Site Infections
• 3rd most common hospital infection
• Incisional
– Superficial
– Deep
• Organ Space
– Generalized (peritonitis)
– Abscess

21. 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%

22. Host Risk Factors
• Diabetes mellitus
• Hypoxemia
• Hypothermia
• Leukopenia
• Nicotine (tobacco smoking)
• Immunosuppression
• Malnutrition
• Poor skin hygiene

23. 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

24. Treatment
• Incisional: open surgical
wound, antibiotics for cellulitis or
sepsis
• Deep/Organ space: Source
control, antibiotics for sepsis

25. 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

27. Other Hospital Acquired
Infections
1. Urinary Tract Infection
2. Indwelling Catheter Infection
3. Pneumonia

28. 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

29. Occupational Blood
Bourne Virus Infections
HBV HCV HIV
Risk from
Needle stick
30% 2% 0.3%
Chemoprophylaxis Yes No Yes
Vaccine Yes No No