WOUND INFECTIONS

By
DR. M. HASSAN ABBAS
MBBS (KE), FCPS (Surgery), FCPS-I (Medicine)
CLASSIFICTION OF WOUNDS
• CLEAN 1.5%
• CLEAN CONTAMINTED 7.7%
• CONTAMINTED15.2%
• DIRTY40%
 CLEAN
• Elective, primarily closed , no acute
inflammation , encountered , no entrance of
normally or frequently colonized body
cavities(GIT,Oropharyngeal, Genitourinary,
Tracheobronchial tracts) and no breaks in
sterile techniques
 CLEAN CONTAMINATED
• NON selective cases that is otherwise a
clean controlled opening of a normally
colonized body cavity,
• Minimal,spillage or break in sterile
techniques,
• Reoperation through clean incision within
7days
• Negative exploration through intact skin
 CONTAMINATED
• Acute nonpurulent inflammation
encountered ,
• Major break in technique or spill from
hollow organ
• Penetrating injury less than 4 hours old
• Chronic open wounds for grafting
CLASSIFICATION Continue…
• DIRTY
• PENETRATING BOWEL INJURY MORE
THAN 4 HOURS OLD
• POURULENCE OR ABSCESES
ENCOUNTERED OR DRAINED. PREOP
PRFORATION OF COLONISED BODY
CAVITY
FACTORS AFFECTING INCIDENCE
OF WOUND INFECTION

• ENDOGENOUS-UNIQUE ATTRIBUTES OF PT
WHICH EITHER MAY OR MAY NOT ( e.g
AGE) BE ALTERABLE PROR TO OP.
• EXOGENOUS-CHARECTERISTIC OF
OPERATIVE EXPERIENCE NOT UNIQUE TO
ANY PT WHICH CAN BE FREQUENTLY
INFLUENCED BY SURGEIONS (e.g LENGTTH
OF OP)
 ENDOGENOUS FACTORS
• AGE
• PREEXISTING ILLNESS
• DIABETES MELLITUS
• OBESITY
 ENDOG-FACTORS
• LENGTH OF PE OPERATIVE
HOSPITALISATION
• TYPE OF OPERATIONS
• MALIGNANCY
• REMOTE SITE INFECTION
………..ENDOGEN FACTORS
• MALNUTRITION
• CIGARETTE SMOKING
 EXOGENOUS FACTORS
• LENGTH OF OPERATION
• GLOVE PUNCTURES
• EMERGENCY PROCEDURES
• TIME OF DAY
• MONTH OF YEAR
• AIRBORNE CONTAMINATION
 WOUND LEVEL FACTORS
AFFECTING INCIDENCE ….
• WOUND CLASS-Clean 1.5 %, clean
contaminated 7.7%, contaminated 15.2%,
dirty 40%
• WOUND CONTAMINATION
• PREOPERATIVE HAIR REMOVAL
• ADHESIVE DRAPES
• WOUND IRRIGATION
 TISSUE LEVEL FATORS AFFECTING
INCIDENCE OF WOUND INFECTIONS

• TISSUE PERFUSION
• LOCAL IMMUNE RESPONSE
 ROLE OF
PROPHYLACTICANTIBIOTICS
• CLEAN WOUNDS-NO NEED,EXCCPT INFECTION CAN
BE DISASTROUS PROSTHESIS,CNS , CARDIAC-I GN
CEPHAL
• CLEAN CONTAMINATED WOUNDS-BENEFIT
.HEADAND NECK, NO CARDIACTHOTACIC, BILIARY,
GU GASTRODUODENAL PROCEDURS IN PTS WITH
IMUNO SUPRESSING , BLEEDING ULCERS OR
GASTRIC CANCER SHOULD RECEIVE
CEFAZOLIN.COLORECTALOR SHD RECEIVE BOWL
PREP

• DIRTY
 DIRTY
• ABD TRAUMA-SHOULD RECV, AND
COMMONLY CONTD IN POST OP
PERIOD AS ACTIVE TREATMENT.
• BOTH GR POSTIVE` GR NEG AEROBIC
AND ANAER COMPONENT TO BE
COVERED. CEFOXITIN. OR GENTA
+CLINDA
PREVENTION/SURVEILANCE
• MARKED REDUCTION IN WI RATE
2.6%TO 0.6%
• CLEAN WOUND INFECTION RATE
3.5%TO < 1%
• SURGICAL WOUND INFECTION TASK
FORCE
 RECOMMENDATONS
• CDC-COMMITEE FOR DISEASE CONTROL,
DEFINITIONS OF WOUND INFECTIONS
• EITHER DIRECT OBSERVATION OR
TRADITIONAL INFECTION CONTROL
SURVEILLANCE TECHNIQUES ARE TO BE
USED FOR CASE FINDING
• POST DISCHARGE SURVEILLANCE FOR
WOUND IINFECTIONS
 …RECOMMENDATIONS
• STUDIES ARE NEEDED TO DETERMINE WHETHER
WOUND INFECTIONS COMPLICATING
OUTPATIENT AND MINOR SURGICAL
PROCEDURES HAVE SIMILAR IMPORTANCE TO WI
DEVELOPING AFTER INPATIENT PROCEDURES
• SURGICAL PROCEDURE CLASSIFICATION
• SURGEON SPECIFIC WOUND INFECTION RATES
SHOULD BE CALCULATED AND REPORTED O
INDIVIDUAL SURGEONS AND CHIEF. THIS
INFORMATION KEPT CODED& CONFIDENTIAL
AND STRATIFIED BY RISK
 SUMMARY
• W I is an important entity for use of time and
resources
• Identification of Risk factors known-preexisting
medical illness, prolonged operative time, wound
contamination,contaminated or dirty wounds
• Tissue level factors-local environment,white
cells,cellular products that mediate inflammation –
their manipulation holds promise for future
therapies
 SUMMARY II
• Judicious use of antibiotic prophylaxis and
organized systems of wound surveillance
are most effective means to reduce Wound
infection to its pathophysiologically
attainable minimum
• Effective and active infection control team
of hospital
 NOT ……LOST WORD
• EVEN THOUGH COMPLETE
ELIMINATION OF WOUND INFECTION
IS NOT POSSIBLE , A REDUCTION OF
THE OBSERVED Wound Infection RATE
TO A MINIMUM LEVEL COULD HAVE
MARKED BENEFITS IN TERMS OF
BOTH PT COMFORT AND
RESOURCRES USED.
 THANK YOU
• THANKS 4 UR PATIENCE