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 (D)</p> Signup and view all the answers

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

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

What is the primary purpose of antibiotic prophylaxis before surgery?

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

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

<p>Cefazolin (D)</p> Signup and view all the answers

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

<p>Depth (D)</p> Signup and view all the answers

What characterizes secondary healing or healing by secondary intention?

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

What defines delayed primary wounds?

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

What is assessed to determine if nonviable tissue can survive?

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

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

<p>Cefazolin (C)</p> Signup and view all the answers

What initial information is gathered regarding a wound in triage?

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

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

<p>Incision and drainage only (C)</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 (B)</p> Signup and view all the answers

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

<p>Cefazolin (A)</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 (A)</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 (C)</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 (A)</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 (B)</p> Signup and view all the answers

What must be done if the fascia becomes infected?

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

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

<p>Second-generation cephalosporins (B)</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 (A)</p> Signup and view all the answers

When is empiric gram-negative therapy often unnecessary?

<p>In the absence of a systemic inflammatory response (A)</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 (B)</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 (C)</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 (C)</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 (A)</p> Signup and view all the answers

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

<p>Fascial dehiscence (D)</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 (C)</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% (B)</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 (A)</p> Signup and view all the answers

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

<p>Presence of purulent material (C)</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 (B)</p> Signup and view all the answers

In which situation would the chances of infection be highest?

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

What defines a wound categorized as Class III/Contaminated?

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

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

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

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

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

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

<p>Malnutrition (A)</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 (D)</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% (C)</p> Signup and view all the answers

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

<p>Inadequate sterilization of instruments (A)</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 (A)</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 (A)</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 (C)</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 (B)</p> Signup and view all the answers

What is a common complication associated with surgical site infections?

<p>Prolonged hospital stay (A)</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 (B)</p> Signup and view all the answers

Flashcards

Superficial SSI

Superficial skin infections, often characterized by redness, swelling, and warmth. They typically occur near the site of incision and may involve drainage.

Organ/Space SSI

A type of bacterial infection that affects deeper tissues and organs. They often involve systemic symptoms like fever and chills.

Wound Exploration and Debridement

A group of procedures performed to remove infected tissue, debris, and pus from a wound.

Antibiotic Prophylaxis

The use of antibiotics before surgery to reduce the risk of post-operative infection.

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Short Course Antibiotics (24-48 hours)

A short course of antibiotics typically used for 24-48 hours to treat cellulitis that doesn't improve with wound opening.

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Empiric Gram-Negative Therapy

Antibiotics prescribed to target specific types of bacteria, often used for infections involving deeper structures and organs.

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Stopping Antibiotics with Resolution of Cellulitis

The process of gradually reducing or stopping antibiotic therapy as the infection resolves and the patient recovers.

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Systemic Inflammatory Response Syndrome

An inflammatory response involving elevated white blood cell count, fever, and other signs of infection.

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Deep SSI

A serious surgical complication affecting the deep tissues, requiring immediate attention in the emergency room.

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Fascial Dehiscence

This happens when a wound's edges fail to properly stick back together, potentially leading to tissue separation.

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Saline Irrigation

This method involves using a saline solution to clean out the wound, removing unwanted debris, and potentially improving healing outcomes.

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Cefazolin

An antibiotic commonly used as the first choice in preventing surgical site infections.

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Diagnostic Laparoscopy

Surgical procedures that involve opening the abdominal cavity to visually assess and potentially treat internal issues, like infection.

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Secondary Intention Healing

A surgical approach that involves removing sutures and leaving the wound open to heal naturally, with frequent cleaning and dressing changes.

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Peak Plasma Concentration

This refers to the highest concentration of a drug in the bloodstream after administration, which is crucial for maximizing antibiotic effectiveness.

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Evacuate Accumulated Fluid or Pus

The act of draining accumulated fluid or pus from an infected area.

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Primary Survey 'ABCDE'

The first step in managing acute wounds, encompassing evaluation of airway, breathing, circulation, disability, and exposure.

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Wound Depth Assessment

Determining the depth of a wound, including the affected structures. This helps decide if the ER or an outpatient setting is appropriate.

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Wound Configuration

Examining the shape and appearance of the wound, noting any factors like contamination. Important for understanding the extent of the wound and its possible cause.

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Nonviable Tissue Identification

Assessing the viability of the wound tissue. Determining if the tissues will survive and heal or need to be removed.

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Secondary Wound Healing

A type of wound healing where the wound is allowed to close naturally, involving inflammation and granulation tissue formation.

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Delayed Primary Wound Closure

A wound that is closed at a later time after initial care and cleaning. Allows time for wound healing and reduces the risk of infection.

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Class II/Clean-Contaminated Wound

Surgical wounds where the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions without usual contamination; examples include biliary tract, appendix, vagina, and oropharynx.

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Clean Wound (Class I)

Surgical wounds where there is blunt trauma but no penetration of the abdominal wall or fascia, considered a clean surgery.

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Class III/Contaminated Wound

Surgical wounds where there is existing clinical infection or perforated viscera, higher risk of infection.

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Class IV/Dirty-Infected Wound

Surgical wounds with significant delay in treatment, presence of necrotic tissue, overt infection, or access to perforated viscus with high contamination.

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Perforated Viscus Wound

A type of Class III/Contaminated wound where the wound is created to access a perforated viscus. The perforated viscus introduces bacteria and contaminants into the surgical site.

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Delayed Wound Treatment

A type of Class IV/Dirty-Infected wound where the wound is significantly delayed in treatment. The delay allows for bacteria to proliferate and increases the risk of infection.

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Wound with Necrotic Tissue

A type of Class IV/Dirty-Infected wound with the presence of necrotic tissue, which attracts bacteria and increases the risk of infection.

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High Contamination Wound

A type of Class IV/Dirty-Infected wound where the wound is created to access a perforated viscus with a high degree of contamination.

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Contaminated Wound

A surgical wound classification where there is a high risk of infection due to the presence of bacteria. This usually occurs when the wound is exposed to the environment or involves a ruptured organ.

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Absorbable Suture

A type of surgical suture that dissolves over time, leaving no need for removal.

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Non-absorbable Suture

A type of surgical suture that does not dissolve and needs to be removed after the wound has healed.

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Meticulous Alignment

A surgical technique that involves carefully aligning the edges of a wound to ensure proper healing.

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Follow-up

The process of monitoring a patient's surgical wound after surgery to ensure it is healing properly.

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Surgical Site Infection (SSI)

Infection of tissues, organs, or spaces exposed during surgery, occurring within 30 days (or up to 90 days for implant involvement).

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Staphylococcus aureus

Colonization with Staphylococcus aureus, with a high incidence of SSI postoperatively.

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Risk Factors for SSI

Factors related to the patient, surgery, and microorganisms that increase the risk of SSI.

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Patient Risk Factors for SSI

Factors related to the patient, such as age, immune status, and underlying conditions.

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Surgical Risk Factors for SSI

Factors related to the surgical procedure, such as the duration of the procedure, type of surgery, and surgical techniques.

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Microbial Risk Factors for SSI

Factors related to the microorganisms involved, such as their virulence and resistance to antibiotics.

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Risk Assessment for SSI

An assessment that identifies factors that might increase a patient's risk of developing SSI.

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Morbidity and Mortality of SSI

A common complication after surgery, leading to prolonged hospital stays, readmissions, and increased mortality.

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Prevention of SSI

Procedures that reduce the risk of SSI by aiming to minimize contamination and inflammation.

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Categorization of Hospitals

A classification of hospitals based on their capabilities and resources. Primary hospitals are smaller, while tertiary hospitals offer a wider range of services.

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Tertiary Hospital

A type of hospital with a wider range of services and more advanced facilities compared to primary or secondary hospitals.

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Morbidly Obese or Malnourished Patient

A patient with a high BMI or severe malnutrition, presenting a significant challenge for surgical procedures.

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Sterile Operating Room

Maintaining a sterile environment during surgery, crucial for reducing SSI risk.

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Antimicrobial Prophylaxis for SSI

Appropriate antibiotic administration before and during surgery to prevent bacterial growth.

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Coexistent Infection

A patient with a pre-existing infection in another body part, increasing their risk of developing SSI.

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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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