The document discusses the history and types of surgical infections. It notes that early surgeons like Joseph Lister, Louis Pasteur, and Ignaz Semmelweis helped reduce infection rates through practices like antisepsis and hand washing. Surgical infections can be community-acquired or hospital-acquired and are classified based on factors like pathogenesis, procession, source, and opportunity. The etiology involves bacteria adherence and numbers, as well as host and local risk factors. Pathology involves bacterial proliferation, inflammation, and tissue damage. Diagnosis considers clinical presentation plus tests and imaging. Management focuses on local wound care, antibiotics, and improving systemic patient conditions.

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