Hannan Surgical Infections Talk

7/28/2019 Hannan Surgical Infections Talk

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Surgical Infections

MS-3 Surgery Clerkship Lecture

Natalia Hannan M.D.

07/05/11


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Ignaz Semmelweis

1847

Realized that washing

hand with a chlorinatedlime solution decreased

incidence of newborn

death from puerperalfever.


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Joseph Lister

1883-1897

British surgeon

Used Carbolic Acid(Phenol) to cleanhands, instruments

and wipe on surgicalwounds drasticallydecreased infections.


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Overview

Recognizing Infection

Soft Tissue Infections

Post-operative Infections

Surgical Site Infection

Hospital Acquired Infections

Antibiotic Prophylaxis

Blood Born Pathogens


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Infection

Infection is defined by:

1. Microorganisms in host tissue or

the bloodstream

2. Inflammatory response to theirpresence.


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Inflammatory Response

Localized:

Rubor, Calor, Dolor, Tumor, and functio

laesa (loss of function)

Systemic:

Systemic Inflammatory Response Syndrome

(SIRS)


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S.I.R.S.

Any Two of the Following Criteria

1. Temperature: < 36.0, >38.0

2. Heart Rate : >90

3. Respiratory Rate: >20

4. WBC: 12,000


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Sepsis

Definition: SIRS plus evidence of local

or systemic infection.

Septic Shock

Definition: Sepsis plus end organhypoprofusion. Mortality of up to

40%


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Soft Tissue Infections:

1. Cellulitis

2. Abscess

3. Necrotizing Infections


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Cellulitis


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Cellulitis

Definition: Diffuse infection with severeinflammation of dermal andsubcutaneous layers of the skin

Diagnosis: Pain, Warmth, Hyperesthesia

Treatment: Antibiotics.

Common Pathogens: Skin Flora

(Streptococcus/Staphylococcus)


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Abscess


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Abscess

Definition: Infectious accumulation ofpurulent material (Neutrophils) in a

closed cavity

Diagnosis: Fluctuant: Moveable and

compressible

Treatment: Drainage


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Necrotizing Soft Tissue

Infection


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Infection

Definition: Deep infection of skin and soft tissuethat may spread rapidly along facial planes.

Diagnosis: Purely Clinical, dishwater discharge,gray tissue, pain out of proportion toexamination, bulla, and dark, golden

discoloration.

Treatment: True Surgical Emergency, Antibiotics


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Infection Common Pathogens

Clostridium

Group A streptococcus

Polymicrobial

Toxic Shock Syndrome Streptococcus

Staphylococcus


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Post-Operative Infections

Fever After Surgery

The Five Ws

Wind: Atelectisis

Water: UTI

Walking: DVT

Wonder Drug: Medication Induced

Wound: Surgical Site Infection


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Surgical Site Infections

3rd most common hospital infection

Incisional

Superficial

Deep

Organ Space

Generalized (peritonitis)

Abscess


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Types of Surgery

Clean Hernia repair

breast biopsy

1.5%

Clean-

Contaminated

Cholecystectomy

planned bowel resection

2-5%

Contaminated Non-preped bowel

resection

5-30%

Dirty/infected perforation, abscess 5-30%


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Host Risk Factors

Diabetes mellitus

Hypoxemia

Hypothermia

Leukopenia

Nicotine (tobacco smoking)

Immunosuppression

Malnutrition

Poor skin hygiene


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Perioperative Risk

Factors Operative site shaving

Breaks in operative sterile technique

Improper antimicrobial prophylaxis

Prolonged hypotension

Contaminated operating room

Poor wound care postoperatively

Hyperglycemia

Wound closure technique


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Treatment

Incisional: open surgical wound,

antibiotics for cellulitis or sepsis

Deep/Organ space: Source control,

antibiotics for sepsis


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Operative Antibiotic

Prophylaxis Decreases bacterial counts at surgical site

Given within 30 minutes prior to startingsurgery

Vancomycin 1-2 hours prior to surgery

Redose for longer surgery Do not continue beyond 24 hours


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Other Hospital Acquired

Infections

1. Urinary Tract Infection2. Indwelling Catheter Infection

3. Pneumonia


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Use/Choice of Antibiotics

Use only when indicated

Start with broad spectrum antibiotics

designed to cover likely pathogens

Take cultures when possible

Deescalate spectrum once pathogen is

know

Have a plan for duration


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Occupational Blood

Bourne Virus InfectionsHBV HCV HIV

Risk from

Needle stick

30% 2% 0.3%

Chemoprophylaxis Yes No Yes

Vaccine Yes No No

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