6-Surgical Infections
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Questions and Answers

What type of suture is recommended for dermal alignment before moving to the epidermal layer?

  • Dermal glues
  • Staples
  • Nonabsorbable sutures
  • Absorbable sutures (correct)

    • Which situation would best classify a surgical wound as contaminated?

  • The use of absorbable sutures
  • The surgical site being clean and dry
  • Presence of induration and drainage (correct)
  • The selection of monofilament sutures

    • When should suture removal be considered post-operation?

  • In the presence of cellulitis
  • After adequate healing of the surgical site (correct)
  • If there is excessive drainage observed
  • When the patient requires further surgical intervention

    • Which of the following captures a moment often cherished by doctors for their emotional significance?

    <p>The cry of a newborn</p> Signup and view all the answers

    What is a preferred suture type for skin closure in surgical wounds?

    <p>Nonabsorbable sutures and staples</p> Signup and view all the answers

    What is the primary purpose of antibiotic prophylaxis before surgery?

    <p>To prevent postoperative infections</p> Signup and view all the answers

    Which antibiotic is considered the drug of choice for many surgical procedures?

    <p>Cefazolin</p> Signup and view all the answers

    In the management of acute wounds, what should be assessed first?

    <p>Depth</p> Signup and view all the answers

    What characterizes secondary healing or healing by secondary intention?

    <p>Intensified inflammatory response</p> Signup and view all the answers

    What defines delayed primary wounds?

    <p>Contaminated wounds closed at a later date</p> Signup and view all the answers

    What is assessed to determine if nonviable tissue can survive?

    <p>Condition of surrounding tissue</p> Signup and view all the answers

    Which of the following is NOT a second-generation cephalosporin mentioned?

    <p>Cefazolin</p> Signup and view all the answers

    What initial information is gathered regarding a wound in triage?

    <p>Wound depth and extent</p> Signup and view all the answers

    What is the primary method of effective therapy for incisional SSIs?

    <p>Incision and drainage only</p> Signup and view all the answers

    Under what circumstance should antibiotic therapy be considered for a patient with cellulitis following surgery?

    <p>If there is significant cellulitis or systemic inflammatory response</p> Signup and view all the answers

    What is the drug of choice for preventing deep surgical site infections?

    <p>Cefazolin</p> Signup and view all the answers

    How long should antibiotics be administered for intra-abdominal organ/space infections after source control?

    <p>4 days</p> Signup and view all the answers

    What major factor influences the risk of developing a surgical site infection (SSI)?

    <p>Surgical management of the wound</p> Signup and view all the answers

    What is the primary purpose of saline irrigation in wound management?

    <p>To remove devitalized tissue and clots</p> Signup and view all the answers

    What is the newly suggested duration for antibiotic therapy in cases of cellulitis that has not improved?

    <p>4 days</p> Signup and view all the answers

    What must be done if the fascia becomes infected?

    <p>Remove the sutures and facilitate abdominal exploration</p> Signup and view all the answers

    Which group of antibiotics is considered when first-generation agents are not sufficient?

    <p>Second-generation cephalosporins</p> Signup and view all the answers

    What is the purpose of administering prophylactic antibiotics before surgery?

    <p>To decrease the risk of post-operative infection</p> Signup and view all the answers

    When is empiric gram-negative therapy often unnecessary?

    <p>In the absence of a systemic inflammatory response</p> Signup and view all the answers

    What is the ideal timing for administering prophylactic antibiotics relative to the surgical incision for drugs like cefoxitin?

    <p>30 minutes before incision</p> Signup and view all the answers

    What is the recommended approach for managing organ/space surgical site infections?

    <p>Diagnostic laparoscopy for abscess evacuation</p> Signup and view all the answers

    Which of the following is NOT a step in wound exploration and debridement?

    <p>Performing an imaging study</p> Signup and view all the answers

    What is the process called when a wound is allowed to heal on its own after exposure?

    <p>Secondary intention healing</p> Signup and view all the answers

    What is one of the major risks associated with deep surgical site infections?

    <p>Fascial dehiscence</p> Signup and view all the answers

    What categorization applies to an operative wound involving the gastrointestinal tract under controlled conditions without contamination?

    <p>Class II/Clean-Contaminated Wound</p> Signup and view all the answers

    What is the estimated percentage chance of having a Surgical Site Infection (SSI) in Class II/Clean-Contaminated Wounds?

    <p>2.4 to 7.7%</p> Signup and view all the answers

    Which of the following scenarios would classify a wound as Class IV/Dirty-Infected?

    <p>A traumatic wound after a significant delay in treatment with necrotic tissue</p> Signup and view all the answers

    What is a characteristic sign of Class IV/Dirty-Infected Wounds?

    <p>Presence of purulent material</p> Signup and view all the answers

    What type of operation would NOT be classified as Class II/Clean-Contaminated Wound?

    <p>An incision into the alimentary tract with a major technique break</p> Signup and view all the answers

    In which situation would the chances of infection be highest?

    <p>Class IV/Dirty-Infected Wounds</p> Signup and view all the answers

    Which of the following is a key feature of Clean-Contaminated Surgery?

    <p>Controlled conditions with no evident infection</p> Signup and view all the answers

    What defines a wound categorized as Class III/Contaminated?

    <p>Wounds with overt infection or material present</p> Signup and view all the answers

    What is the most common health care-associated infection following surgery?

    <p>Surgical site infection (SSI)</p> Signup and view all the answers

    Which factor is NOT associated with the development of surgical site infections?

    <p>Active exercise regimen</p> Signup and view all the answers

    What is the increased incidence of surgical site infections in middle to low income countries primarily attributed to?

    <p>Income deficits and resource availability</p> Signup and view all the answers

    Which of the following is considered a host factor influencing surgical site infection risk?

    <p>Malnutrition</p> Signup and view all the answers

    What defines a surgical site infection according to the Centers for Disease Control?

    <p>Infection occurring near the surgical site within 30 days</p> Signup and view all the answers

    What is the typical risk factor range for developing surgical site infections in patients undergoing inpatient procedures?

    <p>2% to 5%</p> Signup and view all the answers

    Which of the following actions is NOT part of preoperative skin preparation?

    <p>Inadequate sterilization of instruments</p> Signup and view all the answers

    In terms of surgical site infections, which of the following describes a significant surgical technique error?

    <p>Failure to achieve proper hemostasis</p> Signup and view all the answers

    How does the duration of an operative procedure influence surgical site infection risk?

    <p>Increased duration correlates with higher infection risk</p> Signup and view all the answers

    Which of the following is NOT a microbial risk factor for developing surgical site infections?

    <p>Healthy immune system</p> Signup and view all the answers

    Which population is at a higher chance of developing surgical site infections?

    <p>Older patients and the morbidly obese</p> Signup and view all the answers

    What is a common complication associated with surgical site infections?

    <p>Prolonged hospital stay</p> Signup and view all the answers

    What type of hospital is likely to have better surgical facilities compared to primary facilities?

    <p>Tertiary hospitals</p> Signup and view all the answers

    Study Notes

    Surgical Site Infections (SSIs)

    • SSIs are infections of tissues, organs, or spaces exposed during surgery
    • They're the most common healthcare-associated infection post-surgery
    • Often caused by contamination during surgery and postoperative complications

    Incidence of SSIs

    • Incidence varies widely (5% to 30%) based on the surgical site and wound type
    • Higher rates seen in middle and low-income countries due to resource limitations

    Risk Factors for SSIs

    • Patient Factors: Older age, immunosuppression, obesity, diabetes, malnutrition, smoking, renal failure, peripheral vascular disease, anemia, radiation, chronic skin conditions, and a history of recent surgeries
    • Operation Characteristics: Open vs. laparoscopic surgery, poor skin preparation, contamination of instruments, inadequate prophylaxis, prolonged surgical time, tissue necrosis, blood transfusions, carrier state of microorganisms (e.g., Staphylococcus carriage), hypoxia, and hypothermia
    • Co-existing conditions: Diabetes, smoking, and colonization with microorganisms

    Stages of Surgical Operations

    • Preoperative: Length of stay; skin antisepsis; preoperative skin prep; preoperative shaving; duration of surgical scrub
    • Operation: Duration of surgical scrub; skin antisepsis; preoperative skin prep; preoperative shaving; duration of operation; antimicrobial prophylaxis; operating room ventilation; instrument sterilization; surgical technique; hemostasis; obliterating dead space; tissue trauma; foreign material (e.g., surgical drains)
    • Post-operative: Altered immune response; duration of surgical scrub; skin antisepsis; preoperative skin prep; preoperative shaving

    Wound Classification

    • Class I (Clean): No inflammation, no contamination of the respiratory, alimentary, urinary, or reproductive systems. Includes wounds after blunt trauma (no penetration)
    • Class II (Clean-Contaminated): Respiratory, alimentary, urinary, or reproductive tracts entered; no evidence of significant infection present. Includes biliary tract, appendix, vaginal, oropharynx surgeries.
    • Class III (Contaminated): Gross spillage from the gastrointestinal tract, open wounds, acute non-purulent inflammation.
    • Class IV (Dirty-Infected): Old traumatic wounds, existing clinical infection, perforated viscera. Involves necrotic tissue and overt infection.

    Clinical Features & Diagnosis of SSIs

    • Superficial Incisional SSI: Skin/subcutaneous tissue infection;
    • Deep Incisional SSI: Deep soft tissues (e.g., fascia, muscle) infection;
    • Organ/space SSI: Organ/space infection

    Management of SSIs

    • Surgical management: incision and drainage
    • Antibiotics: only when cellulitis or systemic inflammatory response syndrome is present. Shorter treatment courses may be recommended depending on severity

    Wound Healing

    • Hemostasis: stopping the bleeding
    • Inflammation: cellular response within 24-48 hours
    • Proliferation: tissue regeneration
    • Maturation: reorganization of collagen

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    Related Documents

    Surgical Site Infections (SSI) PDF

    Description

    This quiz covers the essential aspects of Surgical Site Infections (SSIs), including their incidence, risk factors, and associated complications. Understand the varying rates of SSIs based on surgical sites, patient factors, and operational characteristics. Test your knowledge on preventing and managing SSIs in surgical settings.

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