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Hospital Infection1 - Coma hypotension tracheal intubation...

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Hospital Infections 6. Nosocomial Wound Infection Risk can be related to the type of surgical procedure performed: Clean Wounds—sterile site entered--risk 1-3%. Clean-Contaminated--Respiratory, or GU tracts entered in controlled circumstances--risk ~ 4% . Contaminated Wounds--Open, Accidental Wounds, Gross Spillage GI Tract, etc.--risk ~ 9%. Dirty Wounds--infected site-risk ~ 13%. Wounds can become infected at many times during hospitalization: The OR may serve as a source through contaminated instruments, personnel, etc. As in urinary tract infections, patient's flora may contaminate the wound, however hospital organisms usually predominate with multiple antibiotic resistances. When S. aureus or Group-A-beta-hemolytic Streptococci cause several infections, one should worry about personnel as carrier. Prophylactic antibiotics administered at time of surgery have been shown to be of benefit in preventing some types of infections. 7. Nosocomial Respiratory Tract Infection
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Unformatted text preview: Coma, hypotension, tracheal intubation, antimicrobics, renal failure, metabolic acidosis, leukocytosis or leukopenia all are associated with colonization of the airway by Gram negative bacilli. Age > 70, thoracic or abdominal surgery associated with increased risk. Colonization of airway does predispose to Nosocomial Pneumonia--23 per cent colonized develop pneumonia versus 4 per cent not colonized. Decreased gastric acidity associated with increased risk of colonization. In 1960's, outbreaks of Nosocomial Pneumonia were related to contaminated respiratory therapy equipment. With current usage of disposable equipment, this is less of a hazard. Gut decontamination regimens recently fashionable, do not increase survival. For some pathogens such as Pseudomonas or Acinetobacter the risk of death increases 2 fold. Prevention includes prone ventilation, early extubation where feasible....
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