SURGICAL SURGICAL INFECTIONINFECTION

DR IMRANA AZIZDR IMRANA AZIZ

ASSISTANT PROFESSOR ASSISTANT PROFESSOR SURGERY SURGERY

A CLASSIFICATION OF A CLASSIFICATION OF WOUNDSWOUNDS

CLEAN CLEAN CLEAN CONTAMINATEDCLEAN CONTAMINATED CONTAMINATEDCONTAMINATED DIRTYDIRTY

1st Qtr2nd Qtr3rd Qtr4th Qtr

PREDISPOSING FACTORS PREDISPOSING FACTORS OF DEVELOPING OF DEVELOPING

INFECTIONINFECTION MALNUTRITIONMALNUTRITION METABOLIC CAUSESMETABOLIC CAUSES IMMUNOSPPRESSIONIMMUNOSPPRESSION COLONISATIONCOLONISATION POOR PERFUSIONPOOR PERFUSION FOREIGN BODYFOREIGN BODY POOR SURGICAL TECHNIQUEPOOR SURGICAL TECHNIQUE

SOURCES OF SOURCES OF INFECTIONINFECTION

PRIMARYPRIMARY

SECONDARYSECONDARY

WOUND GRADING WOUND GRADING SYSTEMSYSTEM

SOUTHHAMPTON WOUND SOUTHHAMPTON WOUND GRADING SYSTEMGRADING SYSTEM

THE ASEPSIS WOUND SCORETHE ASEPSIS WOUND SCORE

O O Normal healingNormal healingLL Normal healing with mild bruisingNormal healing with mild bruisingLaLa Some bruisingSome bruisingLbLb Considerable bruisingConsiderable bruisingLc Lc Mild erythemaMild erythema

LlLl Eyrthema plus other signs of inflammationEyrthema plus other signs of inflammationLla Lla At one pointAt one pointLlbLlb Around suturesAround suturesLlcLlc Along woundAlong woundLld Lld Around woundAround wound

LllLll Clear or haemoserous dischargeClear or haemoserous dischargeLllaLlla At one point on (≤ 2 cm)At one point on (≤ 2 cm)LllbLllb Along wound (> 2 cmAlong wound (> 2 cmLllcLllc larger Volumelarger VolumeLlldLlld Prolonged (> 3 days)Prolonged (> 3 days)

Major ComplicationsMajor ComplicationsIVIV PusPusIVaIVa At one point only (≤ 2 cm)At one point only (≤ 2 cm)IVbIVb Along wound (> 2 cm)Along wound (> 2 cm)VV Deep or severe wound infection with or without tissue breakdown;Deep or severe wound infection with or without tissue breakdown;

haematoma requiring aspirationhaematoma requiring aspiration

CriteriaCriteria PointsPointsAdditional treatmentAdditional treatment 00

Antibiotics for wound infectionAntibiotics for wound infection 1010

Drainage of pus under local anaesthesiaDrainage of pus under local anaesthesia 55

Debridement of wound under general anaesthesiaDebridement of wound under general anaesthesia 1010

Serous discharge*Serous discharge* Daily 0-5Daily 0-5

ErythemaErythema Daily 0-5Daily 0-5

Purulent exudate*Purulent exudate* Daily 0-Daily 0-1010

Separation of deep tissues*Separation of deep tissues* Daily 0-Daily 0-1010

Isolation of bacteria form woundIsolation of bacteria form wound 1010

Stay as in-patient prolonged over 14 days as resultStay as in-patient prolonged over 14 days as result

of wound infection of wound infection 55

TYPES OF INFECTIONTYPES OF INFECTION

LOCALISED INFECTION LOCALISED INFECTION ABSCESSABSCESS CELLULITIS LYMPHANGITISCELLULITIS LYMPHANGITIS SYSTEMIC INFECTIONSYSTEMIC INFECTION SSISSI SIRSSIRS MODSMODS MSOFMSOF

ABCESSABCESS IT IS A LOCALISED COLLECTION OF IT IS A LOCALISED COLLECTION OF

SUPPURATIVE INFECTION CAUSING SUPPURATIVE INFECTION CAUSING SWELLING AND INFLAMMATIONSWELLING AND INFLAMMATION

MAY PRESENT AS SUPERFICIAL OR DEEPMAY PRESENT AS SUPERFICIAL OR DEEP

CLINICAL FEATURES:CLINICAL FEATURES:CALOR,RUBOR DOLOR , CALOR,RUBOR DOLOR , TUMOURTUMOUR

MANAGEMENT: ANTIBIOTICSMANAGEMENT: ANTIBIOTICS DRAINAGE AND DRAINAGE AND

CURRETAGECURRETAGE DRAINAGE UNDER DRAINAGE UNDER

GUIDANCE (U/S, MRI,CT)GUIDANCE (U/S, MRI,CT)

CELLULITISCELLULITIS CELLULITIS IS NON SUPPURATIVE INVASIVE CELLULITIS IS NON SUPPURATIVE INVASIVE

INFECTION OF TISSUESINFECTION OF TISSUES B HAEMOLYTIC STREPTOCOCCIB HAEMOLYTIC STREPTOCOCCI

CLINICAL FEATURES: CLINICAL FEATURES: SIRS,TOXEMIA(FEVER,CHILLS SIRS,TOXEMIA(FEVER,CHILLS RIGORS,TACHYCARDIA,TACHYPNOEA)RIGORS,TACHYCARDIA,TACHYPNOEA)

MANAGEMENT:BROAD SPECTRUM MANAGEMENT:BROAD SPECTRUM

ANTIBOTICSANTIBOTICS

SYSTEMIC SYSTEMIC INFLAMMATORY INFLAMMATORY

RESPONSE SYNDROMERESPONSE SYNDROME SSI:SURGICSL SITE INFECTIONSSI:SURGICSL SITE INFECTION SSI IS DEFINED AS WOUND THAT EITHER SSI IS DEFINED AS WOUND THAT EITHER

DISCARGES SIGNIFICANT QUANTITY OF PUS DISCARGES SIGNIFICANT QUANTITY OF PUS SPONTANEOUSLY OR NEEDS A SECONDARY PROCDURE SPONTANEOUSLY OR NEEDS A SECONDARY PROCDURE TO DRAIN IT TO DRAIN IT

SIRS:SYSTEMIC INFLAMMTORY SIRS:SYSTEMIC INFLAMMTORY RESPONSE SYNDROMESRESPONSE SYNDROMES

MODS: MULTIPLE ORGAN MODS: MULTIPLE ORGAN DYSFUNCTIONDYSFUNCTION

MSOF: MULTI SUSTEM ORGAN FAILUREMSOF: MULTI SUSTEM ORGAN FAILURE

SIRSSIRS

HYPERTHERMIA (>38 C)OR HYPERTHERMIA (>38 C)OR HYPOTHERMIA(<36 C)HYPOTHERMIA(<36 C)

TACHYCARDIA(>90/MINOR TACHYCARDIA(>90/MINOR TACHYPNOEA(>20 /MIN)TACHYPNOEA(>20 /MIN)

WHITE CELL COUNT12X10(9)WHITE CELL COUNT12X10(9)

4X10(9)4X10(9)

SPECIFIC WOUND SPECIFIC WOUND INFECTIONSINFECTIONS

GAS GANGRENEGAS GANGRENE

TETANUSTETANUS

NECROTISING FASCITISNECROTISING FASCITIS

TETANUSTETANUS C.TETANI:C.TETANI:ANAEROBIC,SPORE BEARING,GRAM POSITIVE ANAEROBIC,SPORE BEARING,GRAM POSITIVE

RELEASES EXOTOXIN TETANOSPASMINRELEASES EXOTOXIN TETANOSPASMIN CLINICAL FEATURES: CLINICAL FEATURES: TETANOSPASMINTETANOSPASMIN ACTS ON ACTS ON

MYONEURONAL JUNCTIONS AND MOTOR NEURONES OF MYONEURONAL JUNCTIONS AND MOTOR NEURONES OF ANTERIOR HORN OF THE SPINAL CORDANTERIOR HORN OF THE SPINAL CORD

SHORT PRODROMAL PERIOD:SEVERE MOTOR SHORT PRODROMAL PERIOD:SEVERE MOTOR SPASMS(RESPIRATORY DISTRESS,OPISTHOTONUS ,RISUS SPASMS(RESPIRATORY DISTRESS,OPISTHOTONUS ,RISUS SARDONICUS ) SARDONICUS )

LONG PRODROMAL PERIOD MILD INFECTIONLONG PRODROMAL PERIOD MILD INFECTION MANAGEMENT:TETANUS TOXOID MANAGEMENT:TETANUS TOXOID

PROPHYLAXIS PROPHYLAXIS HUMAN ANTI TOXIN FOR ESTABLISHED HUMAN ANTI TOXIN FOR ESTABLISHED

WOUNDSWOUNDS BENZYPENCILLINBENZYPENCILLIN

NECROTISING FASCITISNECROTISING FASCITIS POLYMICROBIAL SYNERGISTIC INFECTIONPOLYMICROBIAL SYNERGISTIC INFECTION COLIFORMS,STAPHYLOCOCCI,BACTEROIDES , COLIFORMS,STAPHYLOCOCCI,BACTEROIDES ,

ANAEROBIC STREPTOCOCCIAND ANAEROBIC STREPTOCOCCIAND PEPTOSTREPTOCOCCIPEPTOSTREPTOCOCCI

MELENEYS GANGRENEMELENEYS GANGRENE FOURNIERS GANGRENEFOURNIERS GANGRENE MANAGEMENT:BROAD SPECTRUM MANAGEMENT:BROAD SPECTRUM

ANTIBIOTIC THERAPY WITH CIRCULATORY ANTIBIOTIC THERAPY WITH CIRCULATORY SUPPORTSUPPORT

EXCISION AND EXTENSIVE DEBRIDEMENT OF EXCISION AND EXTENSIVE DEBRIDEMENT OF NECROTIC TISSUENECROTIC TISSUE

SKIN GRAFTINGSKIN GRAFTING

GAS GANGRENEGAS GANGRENE C.PERFRINGENS:C.PERFRINGENS:ANAEROBIC SPORE BEARING ANAEROBIC SPORE BEARING

GRAM POSITIVE GRAM POSITIVE

PREDIPOSING FACTORS:TRAUMATIC PREDIPOSING FACTORS:TRAUMATIC MILITTARY MILITTARY WOUNDS ,IMMUNOCOMPROMISED WOUNDS ,IMMUNOCOMPROMISED

CLINICAL FEATURES:CLINICAL FEATURES:OEDMA ,CREPITUS,SKIN OEDMA ,CREPITUS,SKIN BLISTERING ,FEVER,GREYISH SWEET SMELLING BLISTERING ,FEVER,GREYISH SWEET SMELLING DISCHARGE IF NOT TREATED DISCHARGE IF NOT TREATED SHOCK ,COAGULOPATHY,MULTIORGAN FAILURESHOCK ,COAGULOPATHY,MULTIORGAN FAILURE

MANAGEMENT:INTRAVENOUS MANAGEMENT:INTRAVENOUS PENCILLINS , HYPERBARIC OXYGENPENCILLINS , HYPERBARIC OXYGEN

MANAGEMENT OF WOUND MANAGEMENT OF WOUND INFECTIONINFECTION

ANTIBIOTICS:PROPHYLAXISANTIBIOTICS:PROPHYLAXIS CULTURE SPECIFICCULTURE SPECIFIC

DRAINAGE AND DRESSINGSDRAINAGE AND DRESSINGS

DELAYED CLOSURESDELAYED CLOSURES

PREVENTIVE PREVENTIVE MEASURES MEASURES

PREOOERATIVE PREPARATION:PREOOERATIVE PREPARATION:

OPTIMUM PATIENTS CONDITION,EMPIRICAL OPTIMUM PATIENTS CONDITION,EMPIRICAL ANTIBIOTIC COVER ,ASPETIC ANTIBIOTIC COVER ,ASPETIC

CONDITIONS,SHAVING, WASHING HANDSCONDITIONS,SHAVING, WASHING HANDS OPERATIVE;METICULOUS OPERATIVE;METICULOUS

OPERATIVE MANIPULATIONOPERATIVE MANIPULATION AVOID HYPOXIA,HYPOTHERMIAAVOID HYPOXIA,HYPOTHERMIA POSTOOERATIVE:MRSAPOSTOOERATIVE:MRSA

SURGEON SAFTEYSURGEON SAFTEY

USE OF FULL FACE MASK,EYE USE OF FULL FACE MASK,EYE GOOGLESGOOGLES

WATERPROOF DISPOSABLA GOWNSWATERPROOF DISPOSABLA GOWNS DOUBLE GLOVINGDOUBLE GLOVING ESSENTIAL PERSONALESSENTIAL PERSONAL AVOID DIRECT SHARP OBJECT AVOID DIRECT SHARP OBJECT

HANDLINGHANDLING PROPER WASTE DISPOSALEPROPER WASTE DISPOSALE