A surgical site infection is an infection that occurs in the wound created by an invasive surgical procedure. There are three main types of SSI: superficial incisional, deep incisional, and organ/space. Risk factors include patient comorbidities, local wound factors, and microbial factors such as wound class. Prevention focuses on pre-op skin preparation and antibiotics, aseptic technique during surgery, and clean wound care post-op. Severe infections can progress to sepsis, severe sepsis, and multiple organ dysfunction syndrome if not properly treated.
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
ICMR guidelines on antimicrobial use in Sepsis and SSI's in Indiasanyal1981
Sepsis, septic shock, sepsis induced hypotension, SIRS, common pathogens, trends of antimicrobial resistance. Emperical antibiotic therapy, Classification of surgical site infections with specifications regarding site specific pathogens and peri-operative prophylaxis
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
LETS KNOW ABOUT - SURGICAL SITE INFECTION(SSI).
Infections of the incision or organ or space, that occur after surgery.
60% of SSIs -preventable with evidence-based guidelines.
MC and costliest hospital-acquired infections, 20% of all hospital infections.
CLAClassified based on the depth and tissue layers .
Superficial incisional SSI
Primary or secondary.
Deep incisional SSI
Primary or secondary.
Organ/space SSI
SUPERFICIAL INCISIONAL SSI
Infection occurs within 30 days after the operative procedure and involves only skin and subcutaneous tissue of the incision and had 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 is deliberately opened by surgeon and is 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
DEEP INCISIONAL SSI
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 3 months 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 organ/space component of the surgical site.
b. Deep incision spontaneously dehisces or is deliberately opened by a surgeon and is culture-positive or not cultured when 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.Wound that has both superficial and deep incisional infection is classified as DIS
ORGAN SPACE SSI
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 3 months if implant is in place and the infection appears to be related to the operative procedure and 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.
Tyu
A discussion on the risk factors, classification and clinical presentation of surgical site infection. Also elucidates the overview of management approach to SSI.
ICMR guidelines on antimicrobial use in Sepsis and SSI's in Indiasanyal1981
Sepsis, septic shock, sepsis induced hypotension, SIRS, common pathogens, trends of antimicrobial resistance. Emperical antibiotic therapy, Classification of surgical site infections with specifications regarding site specific pathogens and peri-operative prophylaxis
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
LETS KNOW ABOUT - SURGICAL SITE INFECTION(SSI).
Infections of the incision or organ or space, that occur after surgery.
60% of SSIs -preventable with evidence-based guidelines.
MC and costliest hospital-acquired infections, 20% of all hospital infections.
CLAClassified based on the depth and tissue layers .
Superficial incisional SSI
Primary or secondary.
Deep incisional SSI
Primary or secondary.
Organ/space SSI
SUPERFICIAL INCISIONAL SSI
Infection occurs within 30 days after the operative procedure and involves only skin and subcutaneous tissue of the incision and had 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 is deliberately opened by surgeon and is 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
DEEP INCISIONAL SSI
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 3 months 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 organ/space component of the surgical site.
b. Deep incision spontaneously dehisces or is deliberately opened by a surgeon and is culture-positive or not cultured when 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.Wound that has both superficial and deep incisional infection is classified as DIS
ORGAN SPACE SSI
Infection occurs within 30 days after the operative procedure if no implant is left in place or within 3 months if implant is in place and the infection appears to be related to the operative procedure and 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.
Tyu
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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.
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. SURGICAL SITE INFECTION
Definition:
A surgical site infection is an infection that occurs in the wound created by an invasive surgical procedure.
Types of SSI:
• Superficial incisional SSI
• Deep incisional SSI
• Organ / space SSI
3. SUPERFICIAL INCISIONAL SSI
• Infection occurs within 30 days after surgical procedure
• Involves only skin and subcutaneous tissue of the incision
• Patient has at least 1 of the following:
• a. Purulent drainage from the superficial incision
• b. Organism isolated from an aseptically-obtained culture of fluid or tissue
• c. signs or symptoms: pain or tenderness, localized swelling, redness, heat
• d. Diagnosis of superficial SSI by surgeon or attending physician
4. DEEP INCISIONAL SSI
• Infection occurs within 30 days after the operation if no implant is left in place or
within 1 yr. if implant is in place and the infection appears to be related to the
operation.
• Involves deep soft tissues of the incision, e.g., fascial & muscle layers
• Patient has at least 1 of the following:
a. Purulent drainage from deep incision
b. Deep incision spontaneously dehisces or opened by surgeon and is culture
positive or not cultured and fever >38 C, localized pain or tenderness
c. Abscess or other evidence of infection found on direct exam, during invasive
procedure, by histopathologic exam or imaging test
d. Diagnosis of deep SSI by surgeon or attending physician
5. ORGAN/SPACE SSI
• Infection occurs within 30 days after the operation if no implant is left in place or within 1 yr. if implant is in
place and the infection appears to be related to the operation.
• Infection involves any part of the body, excluding the skin incision, fascia, or muscle layers that is opened or
manipulated during the operative procedure
• Patient has at least 1 of the following:
a. Purulent drainage from drain placed into the organ/space
b. Organism isolated from an aseptically-obtained culture of fluid or tissue in the organ/space
c. Abscess or other evidence of infection found on direct exam, during invasive procedure, or by histopathologic or
exam or imaging test
d. Diagnosis of an organ/space infection by a surgeon or attending physician
6. FURTHER CLASSIFICATION
Severity:
a) Minor
• discharge without cellulitis or deep tissue destruction
b) Major
• Pus discharge with tissue breakdown ,
• Partial or total dehiscence of the deep fascial layers of wound
• Systemic illness is present
Time:
a) Early
• Infection presents within 30 days of procedure
b) Intermediate
• Occurs between one and three months
c) Late
• Presents more than three months after surgery
7. PATHOPHYSIOLOGY
• Micro-organisms are normally prevented from causing infection in tissues by:
• mechanical: intact epithelium
• chemical: low gastric pH;
• humoral: antibodies, complement and opsonins;
• cellular: phagocytic cells, macrophages, polymorphonuclear cells and killer lymphocytes.
……….may be compromised by any comorbid condition of the patient, surgical intervention and
treatment leading to SSI.
8. RISK FACTORS FOR DEVELOPING SSI
Patient factor:
• Older age
• Immunosuppression
• Obesity
• Diabetes mellitus
• Chronic inflammatory process
• Malnutrition
• Peripheral vascular disease
• Smoking
• Anemia
• Radiation
• Steroid use
9. Local factor;
• Poor skin preparation
• Contamination of instruments
• Inadequate antibiotic prophylaxis
• Prolonged procedure
• Site and complexity of procedure
• Local tissue necrosis
• Hypoxia
• Hypothermia
10. Microbial factor:
• Wound Class
• Prolonged hospitalization (leading to nosocomial organisms)
• Resistance
12. WOUND CLASS
Clean wounds (class l) :
• Elective surgery excluding GIT,UT,RT.
Clean contaminated (class ll):
• Elective surgery on GIT ,UT, RT
• NO SIGNIFICANT SPILLAGE
Contaminated (class lll) :
• Open wounds (accident) within 4 hours
• Gross spillage from GIT,UT
Dirty (class lV ) :
• Traumatic wounds more than 4 hours
• Perforated viscus
• Abscess /necrotizing fasciitis
13. MANAGEMENT OF SURGICAL SITE INFECTION
• Most SSIs respond to the removal of sutures with drainage of pus if present and,
occasionally, there is a need for debridement and open wound care.
• Incomplete sealing of the wound edges can often be managed by using a
delayed primary or secondary suture or closure with adhesive tape, but in larger
open wounds the granulation tissue must be healthy with a low bioburden of
colonizing or contaminating organisms if healing is to occur.
15. PRE-OP FACTORS
Preoperative antiseptic showering
o Preoperative hair removal
o Patient skin preparation in the operating room
oPreoperative hand/forearm antisepsis( Alcohol solution,
Chlorhexidine gluconate, Iodophors)
o Antimicrobial prophylaxis
16. PROPHYLACTIC ANTIBIOTICS
Clean wounds: no need for antibiotics except:
• Implant as mesh or vascular graft
• Valvular heart disease to prevent infective endocarditis
• In emergency situations as trauma
Recommended dose: one dose 1st generation cephalosporin or (ampicillin +sulbactam)
Clean contaminated:
One dose of 2nd generation of cephalosporin or (ampicillin +sulbactam) + Aminoglycoside
Contaminated:
As above + Metronidazole
17. INTRA OPERATIVE FACTORS
• Operating room environment:
• Temperature: 68o-73oF, depending on normal ambient temp
• Relative humidity: 30%-60%
• Air movement: from “clean to less clean” areas
• Surgical attire and drapes
• Asepsis and surgical technique
18. POST OPERATIVE FACTORS
Incision care
• The type of postoperative incision care:
• closed primarily: the incision is usually covered with a sterile dressing for 24 to 48 hours.
• left open to be closed later: the incision is packed with a sterile dressing.
• left open to heal by second intention: packed with sterile moist gauze and covered with a sterile dressing.
Changing dressings
• Use an aseptic non-touch technique for changing or removing surgical wound dressings.
Postoperative cleansing
• Use sterile saline for wound cleansing up to 48 hours after surgery.
• Advise patients that they may shower safely 48 hours after surgery.
• Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to
drain pus.
• Topical antimicrobial agents for wound healing by primary intention
19. SEVERE INFLAMMATORY RESPONSE SYNDROME AND
SEPSIS
SIRS
• Two of:
• hyperthermia (> 38°C) or hypothermia (< 36°C)
• tachycardia (> 90 /min, no β-blockers) or tachypnea (> 20 /min)
• white cell count > 12 × 109 / l or < 4 × 109 l
• Sepsis is SIRS with a documented infection
• Severe sepsis or sepsis syndrome or MODS is sepsis with evidence of one or more
organ failures [respiratory (acute respiratory distress syndrome), cardiovascular (septic shock follows compromise
of cardiac function and fall in peripheral vascular resistance), renal (usually acute tubular necrosis), hepatic, blood
coagulation systems or central nervous system]
20. MANAGEMENT
Initial evaluation and infection issues
• Initial resuscitation ( cvp :8-12 mm hg, MAP>65 mm hg and urine output>0.5 ml/kg/hr)
• Diagnosis ( via appropriate cultures)
• Antibiotic therapy
• Source control
• Hemodynamic support and adjunctive therapy :
• Fluid therapy
• Vasopressor/inotropic therapy ( MAP> 65) (nor epi and dopamine)
• Steroids
• Recombinant human activated protein c
• Blood product administration (if hb < 7 gm%)
• Mechanical ventilation
• Glucose control
• Prophylaxis ( stress ulcers and dvt)
21. SUMMARY
• SSI is an infected wound or deep organ space
• SIRS is the body’s systemic response to an infected wound
• MODS is the effect that the infection produces systemically
• MSOF is the end-stage of uncontrolled MODS
• MSOF ultimately leads to death.