SURGICAL INFECTIONS: BONE

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SURGICAL INFECTIONS BONE SOFT TISSUES,
INCLUDING MICROBIOLOGY

• Dr. ADEFEMI O. AFOLABI
• DIVISION OF HEPATOBILIARY
• ENDOCRINE SURGERY
• DEPARTMENT OF SURGERY
• COLLEGE OF MEDICINE
• UNIVERSITY OF IBADAN
• IBADAN, NIGERIA.

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HISTORICAL BACKGROUND

• PRE-ANAESTHESIA ERA
• PRE-ANTIBIOTIC ERA
• WAR-TIME SURGERY
• SEMMELWEIS- HAND WASHING PUERPERAL SEPSIS (1847)

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HISTORICAL BACKGROUND

• LOUIS PASTEUR- GERM THEORY(1861)
• JOSEPH LISTER-ANTISEPTIC SURGERY (CARBOLIC ACID
  1865)
• GUSTAV NEUBER- THEATRE AND CAP GOWN (1882)
• BERGMANN SCHIMMELBUSH- STEAM STERILISATION(1886)
  

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HISTORICAL BACKGROUND

• HALSTEAD- GLOVES, BLOODGOOD-GENERAL USE (1898)
• MICKULICZ RADECKI- FACE MASKS
• ANAESTHESIA, BLOOD TRANSFUSION, ANTIBIOTICS
• DISINFECTION STERILISATION

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GENERAL CONSIDERATIONS

• DEFINITION
• PRINCIPLE OF THERAPY
• DETERMINANTS OF INFECTION

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DETERMINANTS OF INFECTION

• MICROBIAL PATHOGENICITY
• HOST DEFENCES
• LOCAL ENVIRONMENT
• SURGICAL TECHNIQUE

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TYPES OF SURGICAL INFECTION

• SKIN AND SOFT TISSUE
• CELLULITIS LYMPHANGITIS
• ABSCESS
• NECROTIZING SOFT TISSUE INFECTIONS
• TETANUS

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TYPES OF SURGICAL INFECTION

• BODY CAVITY
• PERITONITIS
• INTRA-ABDOMINAL ABSCESSES
• EMPYEMA- THORACIS
• GALL BLADDER
• OTHER CLOSED-SPACE INFECTIONS

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IATROGENIC INFECTIONS

• PROSTHETIC DEVICE ASSOCIATED
• JOINT PROSTHESES,
• VENTRICULO-PERITONEAL
• SHUNTS
• e.t.c.
• VASCULAR CATHETER-RELATED INFECTIONS

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HOSPITAL-ACQUIRED(NOSOCOMIAL)INFECTIONS

• WOUND (SURGICAL SITE)
• URINARY TRACT
• RESPIRATORY TRACT
• CATHETER RELATED

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WOUND (SURGICAL SITE) INFECTION

• CLASSIFICATION OF SURGICAL WOUNDS- INFECTION
  RATES
• CLEAN- 1.5-3.9
• CLEAN-CONTAMINATED- 3-4
• CONTAMINATED- 8.5
• DIRTY- 2-40

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WOUND (SURGICAL SITE) INFECTION

• PREVENTION
• OPERATION ROOM ENVIRONMENT
• INSTRUMENTS DRAPES
• HAND-WASHING
• GLOVES, CAPS, MASKS
• PRE-OP. HOSPITALISATION-SHORT
• PRE-OP. SHOWER

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PREVENTION OF WOUND INFECTION

• SHAVING
• TREAT REMOTE INFECTION
• SKIN PREPARATION
• BOWEL PREPARATION
• ADEQUATE GOOD NUTRITION
• GOOD SURGICAL TECHNIQUE
• PROPHYLACTIC ANTIBIOTICS

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SURGICAL MICROBIOLOGY

• BACTERIA
• GRAM VE COCCI
• AEROBIC FACULTATIVELY ANAEROBIC GRAM VE
  BACILLI
• ANAEROBIC BACTERIA
• FUNGI
• VIRUSES- HEPATITIS, H.I.V.

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UCH MICROBIOLOGY LAB SURVEILLANCE REPORT(MAR-DEC
2003)

• PREDOMINANT NOSOCOMIAL ORGANISMS
• Klebsiella spp- 25.3
• S.aureus- 22.7
• E.coli- 21.7
• P. aeruginosa- 13.6
• Pseudo spp- 5.6

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PREDOMINANT NOSOCOMIAL ORGANISMS

• Proteus mirabilis- 4
• Proteus spp- 3.5
• Enterococcus faecalis- 1.5
• Streptococcus pneumoniae- 1
• Non-haemolytic strept- 0.5

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ANTIMICROBIALTHERAPY

• DISTRIBUTION OF ANTIMICROBIAL AGENTS
• USE OF ANTIBIOTICS IN SURGERY
• DRUG ADMINISTRATION
• IMMUNOTHERAPY OF INFECTIONS
• MONOCLONAL ANTIBODIES, e.t.c.

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ACUTE BONE JOINT INFECTIONS

• ACUTE HAEMATOGENOUS OSTEOMYELITIS
• ACUTE SEPTIC ARTHRITIS

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CHRONIC BONE JOINT INFECTIONS

• CHRONIC PYOGENIC OSTEOMYELITIS
• TUBERCULOSIS
• BONES
• JOINTS