SURGICAL INFECTION DR IMRANA AZIZ ASSISTANT PROFESSOR SURGERY

A CLASSIFICATION OF WOUNDS CLEAN CLEAN CLEAN CONTAMINATED CLEAN CONTAMINATED CONTAMINATED CONTAMINATED DIRTY DIRTY

PREDISPOSING FACTORS OF DEVELOPING INFECTION MALNUTRITION MALNUTRITION METABOLIC CAUSES METABOLIC CAUSES IMMUNOSPPRESSION IMMUNOSPPRESSION COLONISATION COLONISATION POOR PERFUSION POOR PERFUSION FOREIGN BODY FOREIGN BODY POOR SURGICAL TECHNIQUE POOR SURGICAL TECHNIQUE

SOURCES OF INFECTION PRIMARY PRIMARY SECONDARY SECONDARY

WOUND GRADING SYSTEM SOUTHHAMPTON WOUND GRADING SYSTEM SOUTHHAMPTON WOUND GRADING SYSTEM THE ASEPSIS WOUND SCORE THE ASEPSIS WOUND SCORE

O Normal healing LNormal healing with mild bruising LaSome bruising LbConsiderable bruising Lc Mild erythema LlEyrthema plus other signs of inflammation Lla At one point LlbAround sutures LlcAlong wound Lld Around wound LllClear or haemoserous discharge LllaAt one point on (≤ 2 cm) LllbAlong wound (> 2 cm Lllclarger Volume LlldProlonged (> 3 days) Major Complications IVPus IVaAt one point only (≤ 2 cm) IVbAlong wound (> 2 cm) VDeep or severe wound infection with or without tissue breakdown; haematoma requiring aspiration haematoma requiring aspiration

CriteriaPoints Additional treatment0 Antibiotics for wound infection10 Drainage of pus under local anaesthesia5 Debridement of wound under general anaesthesia10 Serous discharge*Daily 0-5 ErythemaDaily 0-5 Purulent exudate*Daily 0-10 Separation of deep tissues*Daily 0-10 Isolation of bacteria form wound10 Stay as in-patient prolonged over 14 days as result of wound infection 5

TYPES OF INFECTION LOCALISED INFECTION LOCALISED INFECTION ABSCESS ABSCESS CELLULITIS LYMPHANGITIS CELLULITIS LYMPHANGITIS SYSTEMIC INFECTION SYSTEMIC INFECTION SSI SSI SIRS SIRS MODS MODS MSOF MSOF

ABCESS IT IS A LOCALISED COLLECTION OF SUPPURATIVE INFECTION CAUSING SWELLING AND INFLAMMATION IT IS A LOCALISED COLLECTION OF SUPPURATIVE INFECTION CAUSING SWELLING AND INFLAMMATION MAY PRESENT AS SUPERFICIAL OR DEEP MAY PRESENT AS SUPERFICIAL OR DEEP CLINICAL FEATURES: CALOR,RUBOR DOLOR, TUMOUR CLINICAL FEATURES: CALOR,RUBOR DOLOR, TUMOUR MANAGEMENT: ANTIBIOTICS MANAGEMENT: ANTIBIOTICS DRAINAGE AND CURRETAGE DRAINAGE AND CURRETAGE DRAINAGE UNDER GUIDANCE (U/S, MRI,CT) DRAINAGE UNDER GUIDANCE (U/S, MRI,CT)

CELLULITIS CELLULITIS IS NON SUPPURATIVE INVASIVE INFECTION OF TISSUES CELLULITIS IS NON SUPPURATIVE INVASIVE INFECTION OF TISSUES B HAEMOLYTIC STREPTOCOCCI B HAEMOLYTIC STREPTOCOCCI CLINICAL FEATURES: SIRS,TOXEMIA(FEVER,CHILLS RIGORS,TACHYCARDIA,TACHYPNOEA) CLINICAL FEATURES: SIRS,TOXEMIA(FEVER,CHILLS RIGORS,TACHYCARDIA,TACHYPNOEA) MANAGEMENT:BROAD SPECTRUM ANTIBOTICS MANAGEMENT:BROAD SPECTRUM ANTIBOTICS

SYSTEMIC INFLAMMATORY RESPONSE SYNDROME SSI:SURGICSL SITE INFECTION SSI:SURGICSL SITE INFECTION SSI IS DEFINED AS WOUND THAT EITHER DISCARGES SIGNIFICANT QUANTITY OF PUS SPONTANEOUSLY OR NEEDS A SECONDARY PROCDURE TO DRAIN IT SSI IS DEFINED AS WOUND THAT EITHER DISCARGES SIGNIFICANT QUANTITY OF PUS SPONTANEOUSLY OR NEEDS A SECONDARY PROCDURE TO DRAIN IT SIRS:SYSTEMIC INFLAMMTORY RESPONSE SYNDROMES SIRS:SYSTEMIC INFLAMMTORY RESPONSE SYNDROMES MODS: MULTIPLE ORGAN DYSFUNCTION MODS: MULTIPLE ORGAN DYSFUNCTION MSOF: MULTI SUSTEM ORGAN FAILURE MSOF: MULTI SUSTEM ORGAN FAILURE

SIRS HYPERTHERMIA (>38 C)OR HYPOTHERMIA( 38 C)OR HYPOTHERMIA(<36 C) TACHYCARDIA(>90/MINOR TACHYPNOEA(>20 /MIN) WHITE CELL COUNT12X10(9) 4X10(9)

SPECIFIC WOUND INFECTIONS GAS GANGRENE GAS GANGRENE TETANUS TETANUS NECROTISING FASCITIS NECROTISING FASCITIS

TETANUS C.TETANI: ANAEROBIC,SPORE BEARING,GRAM POSITIVE RELEASES EXOTOXIN TETANOSPASMIN C.TETANI: ANAEROBIC,SPORE BEARING,GRAM POSITIVE RELEASES EXOTOXIN TETANOSPASMIN CLINICAL FEATURES: TETANOSPASMIN ACTS ON MYONEURONAL JUNCTIONS AND MOTOR NEURONES OF ANTERIOR HORN OF THE SPINAL CORD CLINICAL FEATURES: TETANOSPASMIN ACTS ON MYONEURONAL JUNCTIONS AND MOTOR NEURONES OF ANTERIOR HORN OF THE SPINAL CORD SHORT PRODROMAL PERIOD:SEVERE MOTOR SPASMS(RESPIRATORY DISTRESS,OPISTHOTONUS,RISUS SARDONICUS ) SHORT PRODROMAL PERIOD:SEVERE MOTOR SPASMS(RESPIRATORY DISTRESS,OPISTHOTONUS,RISUS SARDONICUS ) LONG PRODROMAL PERIOD MILD INFECTION LONG PRODROMAL PERIOD MILD INFECTION MANAGEMENT:TETANUS TOXOID PROPHYLAXIS MANAGEMENT:TETANUS TOXOID PROPHYLAXIS HUMAN ANTI TOXIN FOR ESTABLISHED WOUNDS HUMAN ANTI TOXIN FOR ESTABLISHED WOUNDS BENZYPENCILLIN BENZYPENCILLIN

NECROTISING FASCITIS POLYMICROBIAL SYNERGISTIC INFECTION POLYMICROBIAL SYNERGISTIC INFECTION COLIFORMS,STAPHYLOCOCCI,BACTEROIDES, ANAEROBIC STREPTOCOCCIAND PEPTOSTREPTOCOCCI COLIFORMS,STAPHYLOCOCCI,BACTEROIDES, ANAEROBIC STREPTOCOCCIAND PEPTOSTREPTOCOCCI MELENEYS GANGRENE MELENEYS GANGRENE FOURNIERS GANGRENE FOURNIERS GANGRENE MANAGEMENT:BROAD SPECTRUM ANTIBIOTIC THERAPY WITH CIRCULATORY SUPPORT MANAGEMENT:BROAD SPECTRUM ANTIBIOTIC THERAPY WITH CIRCULATORY SUPPORT EXCISION AND EXTENSIVE DEBRIDEMENT OF NECROTIC TISSUE EXCISION AND EXTENSIVE DEBRIDEMENT OF NECROTIC TISSUE SKIN GRAFTING SKIN GRAFTING

GAS GANGRENE C.PERFRINGENS: ANAEROBIC SPORE BEARING GRAM POSITIVE C.PERFRINGENS: ANAEROBIC SPORE BEARING GRAM POSITIVE PREDIPOSING FACTORS:TRAUMATIC MILITTARY WOUNDS,IMMUNOCOMPROMISED PREDIPOSING FACTORS:TRAUMATIC MILITTARY WOUNDS,IMMUNOCOMPROMISED CLINICAL FEATURES: OEDMA,CREPITUS,SKIN BLISTERING,FEVER,GREYISH SWEET SMELLING DISCHARGE IF NOT TREATED SHOCK,COAGULOPATHY,MULTIORGAN FAILURE CLINICAL FEATURES: OEDMA,CREPITUS,SKIN BLISTERING,FEVER,GREYISH SWEET SMELLING DISCHARGE IF NOT TREATED SHOCK,COAGULOPATHY,MULTIORGAN FAILURE MANAGEMENT:INTRAVENOUS PENCILLINS, HYPERBARIC OXYGEN MANAGEMENT:INTRAVENOUS PENCILLINS, HYPERBARIC OXYGEN

MANAGEMENT OF WOUND INFECTION ANTIBIOTICS:PROPHYLAXIS ANTIBIOTICS:PROPHYLAXIS CULTURE SPECIFIC CULTURE SPECIFIC DRAINAGE AND DRESSINGS DRAINAGE AND DRESSINGS DELAYED CLOSURES DELAYED CLOSURES

PREVENTIVE MEASURES PREOOERATIVE PREPARATION: PREOOERATIVE PREPARATION: OPTIMUM PATIENTS CONDITION,EMPIRICAL ANTIBIOTIC COVER,ASPETIC CONDITIONS,SHAVING, WASHING HANDS OPTIMUM PATIENTS CONDITION,EMPIRICAL ANTIBIOTIC COVER,ASPETIC CONDITIONS,SHAVING, WASHING HANDS OPERATIVE;METICULOUS OPERATIVE MANIPULATION OPERATIVE;METICULOUS OPERATIVE MANIPULATION AVOID HYPOXIA,HYPOTHERMIA AVOID HYPOXIA,HYPOTHERMIA POSTOOERATIVE:MRSA POSTOOERATIVE:MRSA

SURGEON SAFTEY USE OF FULL FACE MASK,EYE GOOGLES USE OF FULL FACE MASK,EYE GOOGLES WATERPROOF DISPOSABLA GOWNS WATERPROOF DISPOSABLA GOWNS DOUBLE GLOVING DOUBLE GLOVING ESSENTIAL PERSONAL ESSENTIAL PERSONAL AVOID DIRECT SHARP OBJECT HANDLING AVOID DIRECT SHARP OBJECT HANDLING PROPER WASTE DISPOSALE PROPER WASTE DISPOSALE