Surgical Infection FY1 Rosalind Pool

Pathophysiology of Bacterial Infection Presence of bacteria Diminished host resistance Skin barrier breached Suitable environment Warm Wet Food source e.g. carbohydrates, proteins

Surgical Site Infections 20% of all healthcare-associated infections 5% of patients undergoing surgery develop a surgical site infection Significant effect on patient’s quality of life Increased morbidity Extend hospital stay

NICE Guideline 2008 Prevention and Treatment of Surgical Site Infection Pre-operative Intra-operative Post-operative

Pre-operative Patient preparation: Hair removal Wash on day before or day of surgery Hair removal Electric clippers with a single-use disposable head Antibiotic prophylaxis: Clean surgery involving a prosthesis or implant Clean-contaminated surgery Contaminated surgery Dirty

Surgical wound classification Clean: No contamination from GI, Respiratory or genitourinary tracts. Inguinal hernia repair Clean-contaminated: Minimal contamination from GI, Resp, GU tracts Cholecystectomy, TURP Contaminated: Significant contamination from GI, Resp, GU tracts Elective hemicolectomy Appendicectomy Open traumatic wounds that are more than 12–24 hours old also fall into this category. Dirty or infected: Infection present Perforated appendicectomy Bowel perforation

Intra-operative Operating personnel Skin prep Wash hands Sterile gowns and gloves Skin prep Chlorhexidine or povidone-iodine Maintain patient homeostasis Temperature Oxygenation Organ perfusion Dressing Cover surgical incision

Post-operative Dressing of wound Antibiotics Wound care Aseptic non-touch technique for changing dressings Only shower after 48 hours Antibiotics If infection suspected give antibiotics according to local guidelines Wound care Tissue viability nurse

Pyrexia Mild raise is normal early post-op Think 7 Cs

Remember these… Cannula Catheter Cut Central line Chest Clot Collection