Surgical infection

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Slide 1 :

Surgical Infection John Pender, MD BSOM, East Carolina University April 1, 2005

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SSI Superficial Deep Organ/space

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Soft tissue/wound Third most reported nosocomial infections 16% of all reported nosocomial infections Most common surgical patient nosocomial infection (38%) 2/3 involved surgical incision, 1/3 deep structures accessed by incision Deaths in patients with nosocomial infections—77% related to infection.

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SSI 1992 $3,152 in extra charges 1980 extra ten days of hospitalization 12%-84% present after discharge Most present within 21 days

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Risk factors for SSI Diabetes Nicotine Steroids Malnutrition Length of preoperative hospitalization Nares colonization Staph Aureus Perioperative transfusion

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Preop Scrub 10 or 2 min ? With what? Skin prep Iodophors, chlorahexadine, or ETOH Hair removal Night before? NO (5% vs .6%) Antiseptic showering Reduce skin flora only

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Antimicrobrial prophylaxis Clean contaminated procedures Vascular cases Cardiac cases Orthopedic prosthetic cases Second generation cephalosporin for distal intestinal tract Timing

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Class I (clean) Atraumatic wound w/o inflammation. No respiratory, GU,GI,or biliary tract entered Hernia repair ? infection rate

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Class I (clean) Atraumatic wound w/o inflammation. No respiratory, GU,GI,or biliary tract entered Hernia repair 1.5% infection rate

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Class II(clean/contaminated) Controlled entrance into respiratory, GU,GI,or biliary tracts Cholecytectomy, elective bowel resection ? infection rate

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Class II(clean/contaminated) Controlled entrance into respiratory, GU,GI,or biliary tracts Cholecytectomy, elective bowel resection 7.5% infection rate

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Class III(contaminated) Traumatic wounds, major breaks in sterile techniques, gross spillage of GI contents, Acute non-purulent inflammation Appendectomy ? infection rate

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Class III(contaminated) Traumatic wounds, major breaks in sterile techniques, gross spillage of GI contents, Acute non-purulent inflammation Appendectomy 15% infection rate

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Class IV (dirty) Old trauma wounds; devitalized tissue; existing clinical infection, perforated viscera. Hartmann’s for diverticular perforation ? Infection rate

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Class IV (dirty) Old trauma wounds; devitalized tissue; existing clinical infection, perforated viscera. Hartmann’s for diverticular perforation 40% infection

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Merely a flesh wound

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Vulvovaginal Infections

Antibiotic Prophylax...

Surgical Excision of...

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