1. Presented by Dr Azza Serry
Surgical infection
Presented by Dr Azza Serry

2. 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 .

3. 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

4. Gram positive and gram negative bacteria

5. 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

6. 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

7. 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 .

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

9. 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

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

11. 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

12. Diffuse inflammation

13. 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

14. 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

15. 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 years ,and at time of injury
Passive : injection of antitetanic globulin

16. 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 .