FY1 Rosalind Pool

Surgical Infection

Pathophysiology of Bacterial Infection

Presence of bacteria

Suitable environment•Warm•Wet•Food source e.g. carbohydrates, proteins

Diminished host resistance•Skin barrier breached

Surgical Site Infections20% of all healthcare-associated infections5% of patients undergoing surgery develop

a surgical site infectionSignificant effect on patient’s quality of lifeIncreased morbidityExtend hospital stay

NICE Guideline 2008Prevention and Treatment of Surgical Site Infection

Pre-operativeIntra-operativePost-operative

Pre-operativePatient preparation:

Wash on day before or day of surgeryHair removal

Electric clippers with a single-use disposable head

Antibiotic prophylaxis:Clean surgery involving a prosthesis or

implantClean-contaminated surgeryContaminated surgeryDirty

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-operativeOperating personnel

Wash handsSterile gowns and gloves

Skin prepChlorhexidine or povidone-iodine

Maintain patient homeostasisTemperatureOxygenationOrgan perfusion

Dressing Cover surgical incision

Post-operativeDressing of wound

Aseptic non-touch technique for changing dressings

Only shower after 48 hoursAntibiotics

If infection suspected give antibiotics according to local guidelines

Wound careTissue viability nurse

PyrexiaMild raise is normal early post-opThink 7 Cs

Remember these…CannulaCatheterCutCentral lineChestClotCollection