SURGICAL INFECTION DR IMRANA AZIZ ASSISTANT PROFESSOR SURGERY.
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Transcript of SURGICAL INFECTION DR IMRANA AZIZ ASSISTANT PROFESSOR SURGERY.
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SURGICAL SURGICAL INFECTIONINFECTION
DR IMRANA AZIZDR IMRANA AZIZ
ASSISTANT PROFESSOR ASSISTANT PROFESSOR SURGERY SURGERY
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A CLASSIFICATION OF A CLASSIFICATION OF WOUNDSWOUNDS
CLEAN CLEAN CLEAN CONTAMINATEDCLEAN CONTAMINATED CONTAMINATEDCONTAMINATED DIRTYDIRTY
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1st Qtr2nd Qtr3rd Qtr4th Qtr
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PREDISPOSING FACTORS PREDISPOSING FACTORS OF DEVELOPING OF DEVELOPING
INFECTIONINFECTION MALNUTRITIONMALNUTRITION METABOLIC CAUSESMETABOLIC CAUSES IMMUNOSPPRESSIONIMMUNOSPPRESSION COLONISATIONCOLONISATION POOR PERFUSIONPOOR PERFUSION FOREIGN BODYFOREIGN BODY POOR SURGICAL TECHNIQUEPOOR SURGICAL TECHNIQUE
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SOURCES OF SOURCES OF INFECTIONINFECTION
PRIMARYPRIMARY
SECONDARYSECONDARY
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WOUND GRADING WOUND GRADING SYSTEMSYSTEM
SOUTHHAMPTON WOUND SOUTHHAMPTON WOUND GRADING SYSTEMGRADING SYSTEM
THE ASEPSIS WOUND SCORETHE ASEPSIS WOUND SCORE
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O O Normal healingNormal healingLL Normal healing with mild bruisingNormal healing with mild bruisingLaLa Some bruisingSome bruisingLbLb Considerable bruisingConsiderable bruisingLc Lc Mild erythemaMild erythema
LlLl Eyrthema plus other signs of inflammationEyrthema plus other signs of inflammationLla Lla At one pointAt one pointLlbLlb Around suturesAround suturesLlcLlc Along woundAlong woundLld Lld Around woundAround wound
LllLll Clear or haemoserous dischargeClear or haemoserous dischargeLllaLlla At one point on (≤ 2 cm)At one point on (≤ 2 cm)LllbLllb Along wound (> 2 cmAlong wound (> 2 cmLllcLllc larger Volumelarger VolumeLlldLlld Prolonged (> 3 days)Prolonged (> 3 days)
Major ComplicationsMajor ComplicationsIVIV PusPusIVaIVa At one point only (≤ 2 cm)At one point only (≤ 2 cm)IVbIVb Along wound (> 2 cm)Along wound (> 2 cm)VV Deep or severe wound infection with or without tissue breakdown;Deep or severe wound infection with or without tissue breakdown;
haematoma requiring aspirationhaematoma requiring aspiration
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CriteriaCriteria PointsPointsAdditional treatmentAdditional treatment 00
Antibiotics for wound infectionAntibiotics for wound infection 1010
Drainage of pus under local anaesthesiaDrainage of pus under local anaesthesia 55
Debridement of wound under general anaesthesiaDebridement of wound under general anaesthesia 1010
Serous discharge*Serous discharge* Daily 0-5Daily 0-5
ErythemaErythema Daily 0-5Daily 0-5
Purulent exudate*Purulent exudate* Daily 0-Daily 0-1010
Separation of deep tissues*Separation of deep tissues* Daily 0-Daily 0-1010
Isolation of bacteria form woundIsolation of bacteria form wound 1010
Stay as in-patient prolonged over 14 days as resultStay as in-patient prolonged over 14 days as result
of wound infection of wound infection 55
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TYPES OF INFECTIONTYPES OF INFECTION
LOCALISED INFECTION LOCALISED INFECTION ABSCESSABSCESS CELLULITIS LYMPHANGITISCELLULITIS LYMPHANGITIS SYSTEMIC INFECTIONSYSTEMIC INFECTION SSISSI SIRSSIRS MODSMODS MSOFMSOF
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ABCESSABCESS IT IS A LOCALISED COLLECTION OF IT IS A LOCALISED COLLECTION OF
SUPPURATIVE INFECTION CAUSING SUPPURATIVE INFECTION CAUSING SWELLING AND INFLAMMATIONSWELLING AND INFLAMMATION
MAY PRESENT AS SUPERFICIAL OR DEEPMAY PRESENT AS SUPERFICIAL OR DEEP
CLINICAL FEATURES:CLINICAL FEATURES:CALOR,RUBOR DOLOR , CALOR,RUBOR DOLOR , TUMOURTUMOUR
MANAGEMENT: ANTIBIOTICSMANAGEMENT: ANTIBIOTICS DRAINAGE AND DRAINAGE AND
CURRETAGECURRETAGE DRAINAGE UNDER DRAINAGE UNDER
GUIDANCE (U/S, MRI,CT)GUIDANCE (U/S, MRI,CT)
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CELLULITISCELLULITIS CELLULITIS IS NON SUPPURATIVE INVASIVE CELLULITIS IS NON SUPPURATIVE INVASIVE
INFECTION OF TISSUESINFECTION OF TISSUES B HAEMOLYTIC STREPTOCOCCIB HAEMOLYTIC STREPTOCOCCI
CLINICAL FEATURES: CLINICAL FEATURES: SIRS,TOXEMIA(FEVER,CHILLS SIRS,TOXEMIA(FEVER,CHILLS RIGORS,TACHYCARDIA,TACHYPNOEA)RIGORS,TACHYCARDIA,TACHYPNOEA)
MANAGEMENT:BROAD SPECTRUM MANAGEMENT:BROAD SPECTRUM
ANTIBOTICSANTIBOTICS
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SYSTEMIC SYSTEMIC INFLAMMATORY INFLAMMATORY
RESPONSE SYNDROMERESPONSE SYNDROME SSI:SURGICSL SITE INFECTIONSSI:SURGICSL SITE INFECTION SSI IS DEFINED AS WOUND THAT EITHER SSI IS DEFINED AS WOUND THAT EITHER
DISCARGES SIGNIFICANT QUANTITY OF PUS DISCARGES SIGNIFICANT QUANTITY OF PUS SPONTANEOUSLY OR NEEDS A SECONDARY PROCDURE SPONTANEOUSLY OR NEEDS A SECONDARY PROCDURE TO DRAIN IT TO DRAIN IT
SIRS:SYSTEMIC INFLAMMTORY SIRS:SYSTEMIC INFLAMMTORY RESPONSE SYNDROMESRESPONSE SYNDROMES
MODS: MULTIPLE ORGAN MODS: MULTIPLE ORGAN DYSFUNCTIONDYSFUNCTION
MSOF: MULTI SUSTEM ORGAN FAILUREMSOF: MULTI SUSTEM ORGAN FAILURE
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SIRSSIRS
HYPERTHERMIA (>38 C)OR HYPERTHERMIA (>38 C)OR HYPOTHERMIA(<36 C)HYPOTHERMIA(<36 C)
TACHYCARDIA(>90/MINOR TACHYCARDIA(>90/MINOR TACHYPNOEA(>20 /MIN)TACHYPNOEA(>20 /MIN)
WHITE CELL COUNT12X10(9)WHITE CELL COUNT12X10(9)
4X10(9)4X10(9)
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SPECIFIC WOUND SPECIFIC WOUND INFECTIONSINFECTIONS
GAS GANGRENEGAS GANGRENE
TETANUSTETANUS
NECROTISING FASCITISNECROTISING FASCITIS
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TETANUSTETANUS C.TETANI:C.TETANI:ANAEROBIC,SPORE BEARING,GRAM POSITIVE ANAEROBIC,SPORE BEARING,GRAM POSITIVE
RELEASES EXOTOXIN TETANOSPASMINRELEASES EXOTOXIN TETANOSPASMIN CLINICAL FEATURES: CLINICAL FEATURES: TETANOSPASMINTETANOSPASMIN ACTS ON ACTS ON
MYONEURONAL JUNCTIONS AND MOTOR NEURONES OF MYONEURONAL JUNCTIONS AND MOTOR NEURONES OF ANTERIOR HORN OF THE SPINAL CORDANTERIOR HORN OF THE SPINAL CORD
SHORT PRODROMAL PERIOD:SEVERE MOTOR SHORT PRODROMAL PERIOD:SEVERE MOTOR SPASMS(RESPIRATORY DISTRESS,OPISTHOTONUS ,RISUS SPASMS(RESPIRATORY DISTRESS,OPISTHOTONUS ,RISUS SARDONICUS ) SARDONICUS )
LONG PRODROMAL PERIOD MILD INFECTIONLONG PRODROMAL PERIOD MILD INFECTION MANAGEMENT:TETANUS TOXOID MANAGEMENT:TETANUS TOXOID
PROPHYLAXIS PROPHYLAXIS HUMAN ANTI TOXIN FOR ESTABLISHED HUMAN ANTI TOXIN FOR ESTABLISHED
WOUNDSWOUNDS BENZYPENCILLINBENZYPENCILLIN
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NECROTISING FASCITISNECROTISING FASCITIS POLYMICROBIAL SYNERGISTIC INFECTIONPOLYMICROBIAL SYNERGISTIC INFECTION COLIFORMS,STAPHYLOCOCCI,BACTEROIDES , COLIFORMS,STAPHYLOCOCCI,BACTEROIDES ,
ANAEROBIC STREPTOCOCCIAND ANAEROBIC STREPTOCOCCIAND PEPTOSTREPTOCOCCIPEPTOSTREPTOCOCCI
MELENEYS GANGRENEMELENEYS GANGRENE FOURNIERS GANGRENEFOURNIERS GANGRENE MANAGEMENT:BROAD SPECTRUM MANAGEMENT:BROAD SPECTRUM
ANTIBIOTIC THERAPY WITH CIRCULATORY ANTIBIOTIC THERAPY WITH CIRCULATORY SUPPORTSUPPORT
EXCISION AND EXTENSIVE DEBRIDEMENT OF EXCISION AND EXTENSIVE DEBRIDEMENT OF NECROTIC TISSUENECROTIC TISSUE
SKIN GRAFTINGSKIN GRAFTING
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GAS GANGRENEGAS GANGRENE C.PERFRINGENS:C.PERFRINGENS:ANAEROBIC SPORE BEARING ANAEROBIC SPORE BEARING
GRAM POSITIVE GRAM POSITIVE
PREDIPOSING FACTORS:TRAUMATIC PREDIPOSING FACTORS:TRAUMATIC MILITTARY MILITTARY WOUNDS ,IMMUNOCOMPROMISED WOUNDS ,IMMUNOCOMPROMISED
CLINICAL FEATURES:CLINICAL FEATURES:OEDMA ,CREPITUS,SKIN OEDMA ,CREPITUS,SKIN BLISTERING ,FEVER,GREYISH SWEET SMELLING BLISTERING ,FEVER,GREYISH SWEET SMELLING DISCHARGE IF NOT TREATED DISCHARGE IF NOT TREATED SHOCK ,COAGULOPATHY,MULTIORGAN FAILURESHOCK ,COAGULOPATHY,MULTIORGAN FAILURE
MANAGEMENT:INTRAVENOUS MANAGEMENT:INTRAVENOUS PENCILLINS , HYPERBARIC OXYGENPENCILLINS , HYPERBARIC OXYGEN
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MANAGEMENT OF WOUND MANAGEMENT OF WOUND INFECTIONINFECTION
ANTIBIOTICS:PROPHYLAXISANTIBIOTICS:PROPHYLAXIS CULTURE SPECIFICCULTURE SPECIFIC
DRAINAGE AND DRESSINGSDRAINAGE AND DRESSINGS
DELAYED CLOSURESDELAYED CLOSURES
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PREVENTIVE PREVENTIVE MEASURES MEASURES
PREOOERATIVE PREPARATION:PREOOERATIVE PREPARATION:
OPTIMUM PATIENTS CONDITION,EMPIRICAL OPTIMUM PATIENTS CONDITION,EMPIRICAL ANTIBIOTIC COVER ,ASPETIC ANTIBIOTIC COVER ,ASPETIC
CONDITIONS,SHAVING, WASHING HANDSCONDITIONS,SHAVING, WASHING HANDS OPERATIVE;METICULOUS OPERATIVE;METICULOUS
OPERATIVE MANIPULATIONOPERATIVE MANIPULATION AVOID HYPOXIA,HYPOTHERMIAAVOID HYPOXIA,HYPOTHERMIA POSTOOERATIVE:MRSAPOSTOOERATIVE:MRSA
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SURGEON SAFTEYSURGEON SAFTEY
USE OF FULL FACE MASK,EYE USE OF FULL FACE MASK,EYE GOOGLESGOOGLES
WATERPROOF DISPOSABLA GOWNSWATERPROOF DISPOSABLA GOWNS DOUBLE GLOVINGDOUBLE GLOVING ESSENTIAL PERSONALESSENTIAL PERSONAL AVOID DIRECT SHARP OBJECT AVOID DIRECT SHARP OBJECT
HANDLINGHANDLING PROPER WASTE DISPOSALEPROPER WASTE DISPOSALE
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