Presented by Dr Azza Serry Surgical infection Presented by Dr Azza Serry

definition Contamination is mere presence of micro- organisms in the wounds ,when these organisms invade the tissues and produce ill effects ,this is called infection .

Bacteriology Staphylococci : gram positive live in skin and nostril Live in skin and nostril Gives rise to pustules ,,abcesses ,surgical wound infection and pneumonia and pneumonia. Streptococci : gram positive , haemolytic and non haemolytic Haemolytic : live in nasopharynx , cause spreading infection as cellulitis , lymphangitis Non haemolytic : found in mouth and bowel , cause minor infection ,dental abscess

Gram positive and gram negative bacteria

Aerobic gram negative bacilli Escherichia coli (E .coli) : Found in intestinal tract Cause urinary tract infection Pseudomonas : Found in respiratory tract Infect open wounds and burns

Anaerobic bacteria Peptostreptococci and gram negative bacilli ( bacteroids ) Found in skin and mucous membrane Cause wound infection , abscess (gas forming ,foul smelling discharge ) ,and septicaemia

Non specific surgical infection surgical site infection Types of surgical wounds Clean : elective non traumatic wounds , gastrointestinal or urinary is not entered . Clean contamination : elective gastrointestinal or urinary tracts . Contaminated : open accidental wounds encountered within 4 hours ,incision through inflamed , non purulent tissues . Dirty : traumatic wounds more than 4 hours ,purulent infection .

Clinical picture Appears between 5th - 10th post operative days Swollen red painful wound , fever Fluctuation or crepitus may be felt

prophylaxis Surgeon : proper scrubing Prophylactic antibiotics Patient : control diabetes shave hairy areas just before skin incision skin preparation with proper antiseptics Surgeon : proper scrubing proper hemostasis Prophylactic antibiotics

Treatment Remove stiches , keep wound open to allow free exit of pus Antibiotics are used according to culture and sensitivity

Acute abscess Localized suppurative inflammation Staphylococci is commonest cause Presents by : pain ,tender mass ,covering skin is red ,oedematous, headache , fever enlarged tender draining lymph nodes When pus is formed , pain becomes throbbing , hectic fever , Treatment : before suppuration , antibiotics ,hot application ,rest after suppuration , incision and drainage

Diffuse inflammation

Specific surgical infection Tetanus : anaerobic infection caused by neurotoxin of clostridium tetani leads to nervous irritability and muscular contraction Clostridium tetani : gram positive anaerobic bacilli . mode of infection : wounds contaminated with soil or feces tetanus neonatorum : infected umbilical stump

Tonic stage :neck stiffness Clinical picture Incubation period : 2 weeks ,fever ,tachycardia, wound appear inflamed Tonic stage :neck stiffness bitter smile lock jaw Clonic stage : minor stimuli → severe muscular contractions incomplete relaxation in between . back is arched backwards respiratory insufficiency high temperature

prevention Immunization: active - passive Active : tetanus toxoid during childhood at 2 ,4 , 6 months followed by booster dose at 18 months and school age Immunization repeated every 7- 10 years ,and at time of injury Passive : injection of antitetanic globulin

treatment Antitetanic globulin Wound is left open and remove foreign bodies and dead tissues Proper sedation Antibiotics , penicillin Tracheostomy or mechaniacal ventilation severe cases Patient should be isolated in dark room , nasogastric feeding .