geo george thomas house surgeon

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surgical site infection geo george thomas house surgeon general surgery surgical site infection-prevention organisms causing ssi mc - staphylococcus aureus any organism like clostridia,gram negative bacteria can cause ssi colonization - bacteria present in a wound with no symptoms/signs of systemic inflammation contamination - transient exposure of wound to bacteria,usually less than 6 hrs. physiology protective mechanisms are compromised by surgical intervention and treatment. mechanical barrier-skin chemical-low gastric ph humoral- antibodies, complement, opsonin cellular- phagocytic cells, macrophages, pmnl, killer lymphocytes risk factors for increased risk of wound infection metabolic disease- diabetes, uremia, jaundice malnutrition( obesity, weight loss) immunosuppression- cancer, aids, steroids, chemotherapy ,radiotherapy colonization and translocation in gastrointestinal tract poor perfusion-systemic shock/ischemia foreign body material poor surgical technique(dead space, hematoma) factors that determine whether wound will become infected host response virulence and inoculum of infective agent vascularity and health of tissue being invaded presence of dead/foreign tissue presence of antibiotics …

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ive preparation care in operation theatre prophylactic antibiotics enhancement of host defences prophylactic antibiotics to prevent infection after surgery/ instrumentation when local wound defenses are not established-decisive period. maximal blood and tissue levels should be present at the time at which first incision is made and before contamination occurs single shot iv administration at induction of anesthesia repeat antibiotics at 4-hourly interval during surgery as tissue antibiotic levels often fall faster than serum levels during: longoperations excessive blood loss unexpected contamination occurs there is no evidence that further doses of antibiotics after surgery are of any value in prophylaxis against infection and can only result in antibiotic resistance. suggested prophylacic regimens for operations at risk type of surgery organisms prophylactic regimen vascular staph. aureus(mrsa) staph. epidermidis(mrcns) aerobic gram negative bacilli(agnb) 1dose augmentin +/- gentamicin, vancomycin/rifampicin orthopaedic staph. aureus/ epidermidis 1dose augmentin oesophagogastric enterobacteriaceae 1 dose-2nd generation cephalosporin+ metronidazole( sev. contamination) …

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isk of acquiring mrsa, and acquisition of hai. medical and nursing staff should wash hands after any patient contact. alcohol hand gels-substitute for handwashing , donot destroy spores of c. difficile-pseudomembranous colitis in immunocompromised care in ot staff with open, infected skin lesions shouldn’t enter ot. preoperative shaving-immediately before surgery, but hair clipping is best with lowest rate of infection attention to theatre technique and discipline careful and regular surveillance to ensure quality-theatre ventilation, instrument sterilisation, aseptic technique. minimize use of diathermy scrubbing and skin preparation for first operation of day, aqueous antiseptics should be used for handwashing scrub –include nails subsequent scrubbing-washing to elbows, as repeated extensive scrubbing releases more organisms than it removes. antiseptic skin preparation to be standardized alcoholic antiseptic-skin preparation-more than 95 % reduction in bacterial count. ensure sterile caps, masks, gown and sterile gloves minimize movement in and out of ot no evidence that drains, …

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surgical site infection geo george thomas house surgeon general surgery surgical site infection-prevention organisms causing ssi mc - staphylococcus aureus any organism like clostridia,gram negative bacteria can cause ssi colonization - bacteria present in a wound with no symptoms/signs of systemic inflammation contamination - transient exposure of wound to bacteria,usually less than 6 hrs. physiology protective mechanisms are compromised by surgical intervention and treatment. mechanical barrier-skin chemical-low gastric ph humoral- antibodies, complement, opsonin cellular- phagocytic cells, macrophages, pmnl, killer lymphocytes risk factors for increased risk of wound infection metabolic disease- diabetes, uremia, jaundice malnutrition( obesity, weight loss) immunosuppression- cancer, ai...

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