Chapter 8: Surgical infections Flashcards

Essential Of GS
Terms Definitions
risk factor?
local wound, systemic
how to formulate risk of infection
density and virulence over resistance of host
why is wound hematoma, necrotic tissue, foreign body, obesity, contamination local risk factors?
-iron rich, a barrier to defense, portals of bac. entry, less perfusion and less airy, high dose of bac
systemic risk factor?
hypoperfusion, less oxy, more CO2 --> metabolic acidosis--> weekens host defense (shock..); comorbid: DM, obesity, malnutrition (anorexia, alcoholics. .); immunocompromised: steroids use, cancer chemo, transplant drugs, old age, chronic dz
wound classifications?
clean, clean- contaminated, contaminated, dirty
surgical site infection
clean wounds how? by what? from where? how frequent?
gram + from staff, OR, skin, elective surgery no GI or biliary involved, 3%
clean contaminated wounds how? by what? from where? how frequent?
elective but do GI or biliary, pt's flora, polymicrobial, 5-15%
contaminated wounds how? by what? from where? how frequent?
not elective, unwanted accidental "spill" prior or during elective operation, from pt's flora, gross contamination, polymicrobial, frequency depends on severity of spillage (15-40%)
dirty wounds how? by what? from where? how frequent?
established infection, polymicrobial, 40-50%
categories of SSI based on?
level of penetration
level of penetration
- superficial and incisional: skin and subQ --> simple cellulitis to above fascia --> oral ABTs and incision and drainage
- deep incision: muscle and fascia--> necrotizing fasciitis, systemic infection, sepsis --> opening, debridement, IV broadspectrum ABTs
- deep space infection: after surgery (secondary peritonitis, intra-ab abcess, empyema) -> explore, drainage, open again, IV ABTs, CT for dx
why don't we want drug resistance? why don't we want to just give everybody abts for px?
once resistance mutation for a drug occurs, the continued use of the ABTs preferentially promotes the growth of the resistant organism by eliminating the sensitive microbial population
Post op fever
Wind (atelectasis) 1-2 --> encourage deep breathing, cough, suction
Water (UTI) 2-3
Wound (infected) 3-5
Walk ( IV phlebitis or DV thrombophlebitis) 5-7
Wonder where (deep infections = abscess, late occurence) 7-10
Wonder drugs any time after the above is ruled out
How to prevent ventilator associated pneumonia? (because it happens in 5-40% of pt, and cause death in 15-20% of cases)
1. raise bed to 30 degree
2. daily sedation vacation and assessment for weaning
3. px for stress/ pressure ulcer
4. px for VTE
Frequent airway suction is integral
How to dx VAP? tx?
- clinical dx
- quantify by bronchial specimens of > 10K organism/mL of aspiration
Tx: ABTs covers MRSA and gram - rod for 8 days
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