SURGICAL INFECTION

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SURGICAL INFECTION

• DR IMRANA AZIZ
• ASSISTANT PROFESSOR SURGERY

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A CLASSIFICATION OF WOUNDS

• CLEAN
• CLEAN CONTAMINATED
• CONTAMINATED
• DIRTY

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PREDISPOSING FACTORS OF DEVELOPING INFECTION

• MALNUTRITION
• METABOLIC CAUSES
• IMMUNOSPPRESSION
• COLONISATION
• POOR PERFUSION
• FOREIGN BODY
• POOR SURGICAL TECHNIQUE

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SOURCES OF INFECTION

• PRIMARY
• SECONDARY

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WOUND GRADING SYSTEM

• SOUTHHAMPTON WOUND GRADING SYSTEM
• THE ASEPSIS WOUND SCORE

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• O Normal healing
• L Normal healing with mild bruising
• La Some bruising
• Lb Considerable bruising
• Lc Mild erythema
• Ll Eyrthema plus other signs of inflammation
• Lla At one point
• Llb Around sutures
• Llc Along wound
• Lld Around wound
• Lll Clear or haemoserous discharge
• Llla At one point on ( 2 cm)
• Lllb Along wound (gt 2 cm
• Lllc larger Volume
• Llld Prolonged (gt 3 days)
• Major Complications

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• Criteria Points
• Additional treatment 0
• Antibiotics for wound infection 10
• Drainage of pus under local anaesthesia 5
• Debridement of wound under general
  anaesthesia 10
• Serous discharge Daily 0-5
• Erythema Daily 0-5
• Purulent exudate Daily 0-10
• Separation of deep tissues Daily 0-10
• Isolation of bacteria form wound 10
• Stay as in-patient prolonged over 14 days as
  result
• of wound infection 5

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TYPES OF INFECTION

• LOCALISED INFECTION
• ABSCESS
• CELLULITIS LYMPHANGITIS
• SYSTEMIC INFECTION
• SSI
• SIRS
• MODS
• MSOF

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ABCESS

• IT IS A LOCALISED COLLECTION OF SUPPURATIVE
  INFECTION CAUSING SWELLING AND INFLAMMATION
• MAY PRESENT AS SUPERFICIAL OR DEEP
• CLINICAL FEATURESCALOR,RUBOR DOLOR , TUMOUR
• MANAGEMENT ANTIBIOTICS
• DRAINAGE AND
  CURRETAGE
• DRAINAGE UNDER
  GUIDANCE (U/S, MRI,CT)

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CELLULITIS

• CELLULITIS IS NON SUPPURATIVE INVASIVE INFECTION
  OF TISSUES
• B HAEMOLYTIC STREPTOCOCCI
• CLINICAL FEATURES SIRS,TOXEMIA(FEVER,CHILLS
  RIGORS,TACHYCARDIA,TACHYPNOEA)
• MANAGEMENTBROAD SPECTRUM ANTIBOTICS

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SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

• SSISURGICSL SITE INFECTION
• SSI IS DEFINED AS WOUND THAT EITHER
  DISCARGES SIGNIFICANT QUANTITY OF PUS
  SPONTANEOUSLY OR NEEDS A SECONDARY PROCDURE TO
  DRAIN IT
• SIRSSYSTEMIC INFLAMMTORY RESPONSE SYNDROMES
• MODS MULTIPLE ORGAN DYSFUNCTION
• MSOF MULTI SUSTEM ORGAN FAILURE

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• SIRS
• HYPERTHERMIA (gt38 C)OR HYPOTHERMIA(lt36 C)
• TACHYCARDIA(gt90/MINOR TACHYPNOEA(gt20 /MIN)
• WHITE CELL COUNT12X10(9)
• 4X10(9)

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SPECIFIC WOUND INFECTIONS

• GAS GANGRENE
• TETANUS
• NECROTISING FASCITIS

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TETANUS

• C.TETANIANAEROBIC,SPORE BEARING,GRAM POSITIVE
  RELEASES EXOTOXIN TETANOSPASMIN
• CLINICAL FEATURES TETANOSPASMIN ACTS ON
  MYONEURONAL JUNCTIONS AND MOTOR NEURONES OF
  ANTERIOR HORN OF THE SPINAL CORD
• SHORT PRODROMAL PERIODSEVERE MOTOR
  SPASMS(RESPIRATORY DISTRESS,OPISTHOTONUS ,RISUS
  SARDONICUS )
• LONG PRODROMAL PERIOD MILD INFECTION
• MANAGEMENTTETANUS TOXOID PROPHYLAXIS
• HUMAN ANTI TOXIN FOR ESTABLISHED WOUNDS
• BENZYPENCILLIN

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NECROTISING FASCITIS

• POLYMICROBIAL SYNERGISTIC INFECTION
• COLIFORMS,STAPHYLOCOCCI,BACTEROIDES , ANAEROBIC
  STREPTOCOCCIAND PEPTOSTREPTOCOCCI
• MELENEYS GANGRENE
• FOURNIERS GANGRENE
• MANAGEMENTBROAD SPECTRUM ANTIBIOTIC THERAPY
  WITH CIRCULATORY SUPPORT
• EXCISION AND EXTENSIVE DEBRIDEMENT OF
  NECROTIC TISSUE
• SKIN GRAFTING

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GAS GANGRENE

• C.PERFRINGENSANAEROBIC SPORE BEARING GRAM
  POSITIVE
• PREDIPOSING FACTORSTRAUMATIC MILITTARY WOUNDS
  ,IMMUNOCOMPROMISED
• CLINICAL FEATURESOEDMA ,CREPITUS,SKIN BLISTERING
  ,FEVER,GREYISH SWEET SMELLING DISCHARGE IF NOT
  TREATED SHOCK ,COAGULOPATHY,MULTIORGAN FAILURE
• MANAGEMENTINTRAVENOUS PENCILLINS , HYPERBARIC
  OXYGEN

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MANAGEMENT OF WOUND INFECTION

• ANTIBIOTICSPROPHYLAXIS
• CULTURE SPECIFIC
• DRAINAGE AND DRESSINGS
• DELAYED CLOSURES

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PREVENTIVE MEASURES

• PREOOERATIVE PREPARATION
• OPTIMUM PATIENTS CONDITION,EMPIRICAL
  ANTIBIOTIC COVER ,ASPETIC CONDITIONS,SHAVING,
  WASHING HANDS
• OPERATIVEMETICULOUS OPERATIVE MANIPULATION
• AVOID HYPOXIA,HYPOTHERMIA
• POSTOOERATIVEMRSA

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SURGEON SAFTEY

• USE OF FULL FACE MASK,EYE GOOGLES
• WATERPROOF DISPOSABLA GOWNS
• DOUBLE GLOVING
• ESSENTIAL PERSONAL
• AVOID DIRECT SHARP OBJECT HANDLING
• PROPER WASTE DISPOSALE

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