SURGICAL SITE INFECTION.pptx

General principles in management and prevention of surgical wound infection

1. SURGICAL SITE INFECTION Presenter: Dr. Moses Cletus Moderator: Dr. Bashir

2. OUTLINE INTRODUCTION DEFINITION CLASSIFICATION TYPES SOURCES PATHOGENESIS CLINICAL PRESENTATION INVESTIGATION PREVENTION MANAGEMENT COMPLICATIONS CONCLUSION

3. INTRODUCTION All surgical wounds are contaminated by bacteria, but only a minority actually demonstrate clinical infection Surgical site infection are not an extinct entity as they account for 3 rd most common hospital infection In Nigeria incidence ranges from 14-27% with highest incidence in north-east( Ahmed et al 2018) making it a major patient safety concern in hospital <1900 – Mortality was about 70-80% >1900- Joseph Lister- brought antiseptic surgery

4. Definition Definition Of Terms: Contamination- the mere presence of pathogenic microorganism on a surface Colonization- the replication/proliferation of microorganism Infection- the host immune response to the invasion of rapidly replicating microorganism SIRS- systemic manifestation to the presence of infection(has many variables) Sepsis- Documented or suspected infection with some of the findings of SIRS. Has 2 subset( severe sepsis and septic shock)

5. Surgical Site Infection- Are infection of the tissue ,organ or space exposed during performance of an invasive procedure usually occurring within 30days of the procedure or 1y if with implants. It was a revision in 1992 by CDC from wound infection to prevent confusion

6. Classification Base on severity

7. Base on degree of contamination

8. Base on duration

9. Types

10. Pathogenesis

11. Sources Exogenous Surgeons, nurses and other staffs Medical equipment Other patient Endogenous Skin flora Other infection in patients Blood transfusion

12. Risk factors Patient factors Microbial factors Local factors

13. Patients factors age obesity immunosuppression DM malnutrition smoking anemia steroids use

14. Microbial factor P rolong hospitalization Resistance to clearance(capsule formation) Virulence(toxin secretion)

15. Local factors E xcessive use of cautery Poor skin preparation B raided sutures Drains/catheters Inadequate antibiotic prophylaxis Hypoxia Hypothermia Contaminated instrument

16. Wound scoring system

17. Score 0-10=satisfactory healing 11-20=disturbance of healing 20-30=minor wound infection 31-40= moderate wound infection >41= severe wound infection

18. Risk assessment SCENIC SCORE -abdominal surgery -operation >2hours - class iii and iv ->3diagnosis at discharge from hospital Risk score od 0=1% ,1=3.6%, 2=9%, 3=17% and 4=27% risk of infection

19. Clinical presentation Local- pain/tenderness, swelling, warmth, induration, shiny erythematous skin, purulent discharge Systemic- pyrexia, chills, malaise, increase HR and RR Non-specific- fever, erythema , leucocytosis

20. Investigation Diagnosis is clinical, Investigation helps in treatment and follow up MCS, Tissue biopsy USS FBC+D For underlying conditions e.g DM, foreign body, anastomotic breakdown, fistula formation

21. Prevention General principles involve maneuvers to Diminish presence of exogenous sources (surgeons, theatre, ward ,other patients) Diminish presence of endogenous sources(patient) antimicrobial, chemically, mechanically etc

22. Management The precept of mgt differs -Drainage of all purulent material -Debridement of all infected, devitalized tissue and debris -Removal of foreign bodies at site of infection -Antimicrobial agents

23. Complications Depend on site of infection, nature of surgery and underlying host factor Early -Necrotizing fasciitis -Wound dehiscence -Metastatic abscess - Septisemia -Organ failure Late -Incisional hernia -Deforming scar

24. SSI is a major problem in surgical practice despite been preventable It is the responsibility of all health care provider to work towards its prevention with a team approach involving the patient, surgeon and hospital management team

25. Reference Schwartz's principle of surgery chpt6 E.A Badoe Principles and Practice of surgery 4 th ed. Bailey and Love 26 th ed. Chpter 5 pg 51-57 Africa Journals Online, S Afr Fam Vol 56 No2, dept anaesthesia chris hani university of witwatersrand

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