Prevention of Sepsis

1
Prevention of Sepsis

• Handwashing
• Skin preparation
• Tissue Handling
• Minimise trauma
• Avoid damage to blood vessels
• Minimise blood loss
• Obliterate dead space
• Minimise foreign material
• Antibiotic prophylaxis

2
Surgical Drains

• Indications
• Prevent accumulation of fluid
• Blood
• Pus
• Infected fluids
• Prevent accumulation of air/gas
• Characterise fluid

3
Surgical Drains

• Types
• Open
• Simple (corrugated tubes or sheets)
• Can increase the risk of infection in
  non-infected cases
• Closed
• Reduce the risk of infection
• Passive
• Differential pressure or gravity
• Active
• Suction - low or high pressure (Redivac)
• Rubber
• Inflammatory - may encourage tract formation
• Silastic
• Inert

4
Surgical Drains

• Types
• Penrose
• Soft rubber tube
• Dependent Drainage - gravity
• Open
• Jackson-Pratt
• Closed
• Collection bulb low grade suction
• Negative Pressure Wound Therapy
• Enclosed foam suction
• Healing of large areas by granulation

5
Surgical Drains

• Practical Points
• Drain must be secured (but removable)
• Fluid drained must be measured (accurately)
• Include fluid drained in fluid balance
• Monitor changes in character of fluid drained

6
Surgical Drains

• Removal
• Always use aseptic technique
• As soon as possible
• The longer in situ, the greater the risk of
  infection
• When drainage lt 25 ml/day
• Shortening - gradual removal
• Useful when draining part of the body that
  normally secrete fluid, e.g. peritoneum.
• Analgesia may be needed
• Send tip to lab. for culture, if available

7
Surgical Drains

• Evidence
• Paucity
• Remember No evidence of effect is NOT the same
  as evidence of no effect.
• Not recommended in uninfected or uncomplicated
  cases.
• In complex cases, understand the problem and the
  benefits to be gained by using a drain.
• Remove as soon as possible when job done to avoid
  introducing infection.

8
Any Questions?
9
Bacteriology Samples

• Time of pyrexia
• Pre-antibiotics
• Sample taken properly (aseptic technique)
• Specimen to lab ASAP (particularly anaerobes)
• Swabs in transport media
• Label correctly

10
U.T.I.
General Population Hospital Population

• E. Coli 69
• Proteus mirabilis 4.3
• Klebsiella 4.7
• Enterococcus 5.5
• Staph spp 4.0
• Pseudomonas 11