PREVENTION AND TREATMENT

of SURGICAL INFECTION

INTRODUCTION
The risk factors for developing a
wound infection
The preoperative (prehospital) component
The operative environment
The microbial factors

CLASSIFICATION OF SURGICAL WOUNDS


CLASSIFICATION OF SURGICAL WOUNDS


Classification of Operative Wounds
and Surgical infection rates
Health care-associated infection (HAI) /
Nosocomial Infections in Surgical Patients

Potential sites:
UTIs
Pneumonia
surgical site (wound) infections (SSIs)
bloodstream infection bacteremia


Principles Of Prevention To Infection

Preoperative Shower
Remote-Site Infection and Shaving
Hand Washing
Shoe Covers, Caps, Masks, Gowns, and Gloves
Core Body Temperature
Postoperative Care
Surgical Wound Management and Surgical
Wound Infection Care






Remote-Site Infection and Shaving

The presence of a remote-site infection,
whether it is a pustule, an upper respiratory
infection, or urinary tract infection, needs to be
identified and treated prior to any surgical
intervention
A patient whose surgical site has been shaved
has an infection rate two to three times higher
than patients who are not shaved
The need for shaving a surgical site should be
considered not for sanitary reasons but only for
the convenience of the patients wound care.

Hand Washing


Shoe Covers, Caps, Masks, Gowns,
and Gloves


Core Body Temperature

The presence of the cold environment in the
operating room reduces the patients core body
temperature
This reduction in the patients core temperature
significantly increases the risk of postoperative
infection
This requires meticulous attention to keeping the
patient warm

Postoperative Care

Supportive therapy
Monitoring Postoperative Fever
Blood and radiographic tests
Surgical Wound Management

Surgical Wound Management and
Surgical Wound Infection Care

Topical Wound Treatment
CLOSED WOUNDS
OPEN WOUNDS

Closed wound
Healing by primary intention
Closed wounds should be kept sterile for 24-48 h until
epithelialization is complete
Tensile strength is only 200/0 of normal skin at 3 weeks
when collagen cross-linking is becoming significant. At 6
weeks, wounds are at 70% of the tensile strength of normal
skin, which is nearly the maximal tensile strength achieved
by scar (75%-80% of normal).
Open Wound
Necrotic material should be removed
Open wounds heal optimally in a moist, sterile environment
The wound is open, and the edges are not approximated
The suture closed as delayed primary closure after 25 days
These wounds heal by contraction and epithelialization.
Secondary closure of wound
The wound is open, and the edges are not approximated. A
potentially contaminated wound is best left open lightly packed
with damp saline soaked gauze and the suture closed as delayed
primary closure after 25 days

MICROBIAL FACTORS OF IMPORTANCE IN
THE DEVELOPMENT OF INFECTION

Two major reservoirs:
(1) host endogenous microflora
(2) microbes within the external milieu, which
often represents the nosocomial
environment for hospitalized individuals
ANTIBIOTICS IN SURGERY
Prophylactic antibiotics
Antibiotic Therapy

Prophylactic antibiotics
Empirical cover against expected pathogens with local
hospital guidelines
Single-shot intravenous administration at induction of
anaesthesia
Repeat only in prosthetic surgery, long operations or if
there is excessive blood loss
Continue as therapy if there is unexpected
contamination
Patients with heart valve disease or a prosthesis should
be protected from bacteraemia caused by dental work,
urethral instrumentation or visceral surgery

Prophylactic antibiotics
Medical considerations that compromise the
healing capacity or increase the infection risk:
Diabetes
Peripheral vascular disease
Possibility of gangrene or tetanus
Immunocompromise

Prophylactic antibiotics
High-risk wounds or situations:
Penetrating wounds
Abdominal trauma
Compound fractures
Wounds with devitalized tissue
Lacerations greater than 5 cm or stellate lacerations
Contaminated wounds
High risk anatomical sites such as hand or foot
Biliary and bowel surgery.

Antibiotic Therapy

A narrow-spectrum antibiotic may be used to
treat a known sensitive infection

Combinations of broad-spectrum antibiotics
can be used when the organism is not known
Principles for the use of antibiotic
therapy
Antibiotics do not replace surgical drainage of
infection
Only spreading infection or signs of systemic
infection justifies the use of antibiotics
Whenever possible, the organism and sensitivity
should be Determined
Treatment of commensals that have become
opportunist pathogens

They are likely to have multiple antibiotic resistance

It may be necessary to rotate antibiotics


HIV, AIDS AND THE SURGEON
Involvement of surgeons with HIV patients
(universal precautions):

use of a full face mask ideally, or protective spectacles;
use of fully waterproof, disposable gowns and drapes,
particularly during seroconversion;
boots to be worn, not clogs, to avoid injury from dropped
sharps;
double gloving needed
allow only essential personnel in theatre;
avoid unnecessary movement in theatre;
respect is required for sharps, with passage in a kidney dish;
a slow meticulous operative technique is needed with
minimised bleeding.


Thank You