Wound Infection 2
Transcript of Wound Infection 2
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Wound Infection
Dr. Nisreen Anfanan
Dr .T.Zamzami
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Definition of Wound InfectionDefinition of Wound Infection
SuperficialSuperficial
Involve skin&sc tissueInvolve skin&sc tissue
Deep( Narcotizing Falsities)Deep( Narcotizing Falsities)
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Incidence of wound infectionSite Incidence
International 5-34 %
USA
14-16 %
KKUH for CS 4.5 %
KAUH ??
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Surgical Operation Classification
Clean < 2 %
Clean-contaminated
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Wound Healing
*Inflamation
vascular
cellular*Epithalisation
*Fibroplasia
*Wound contraction
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Wound infection in gyne ward in
KAUH in 2002 13 cases ??
Post cesarean section 8 cases ??
Post myomectomy 2 cases
Post lap for ectopic pregnancy 1 case
Post lap for endometrial cancer 1case Post lap for ovarian cancer 1 case
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Risk FactorsAltered immunocomptence
Old age
Obesity
Prolong preoperative hospitalization
Excessive blood loss
Prolong operative time
Poor nutrition
Excessive devitalize tissue
Failure to use prophylactic antibiotic
Surgery of an infected operative site
Diabetes mellitus
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Pathogens commonly associated
with wound infectionPATHOGEN FREQUENCY %
Staphylococcus aureus 20
Coagulase-neg stphylococci 14Enterococci 12
E-coli 8
Pseudomonas aeruginosa 8Enterobacter species 7
Klebsiella pneumonia 3
Bacteriod fragilis 2
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Prevention
1- Preoperative assessment
Identify&treat all infections remote from
the surgical site
Surgical site hair removal (level 1a)
Stop smoking
Optimize blood glucose (level 1b)
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Prevention
2- Theater environment&care of instrumentationAppropriate filters
Air should enter through theceiling&exit near the floorMaintain positive pressure ventilation of OR
Maintain mini of 15air changes/hr
( category 1B)
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Prevention
3)Preoperative and postoperative wound care
*Handle tissues gently with good
homeostasis*minimized dead space
* contaminated, dirty-infected wound use
delayed closure(secondary intention)level 1b
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Prevention
4) ANTIBIOTIC PROPHYLAXIS IN SURGERY
*Choice of antibiotic
*Comprehensive risk assessment for chooseof antibiotic
*Clean procedures ( issue of
debate) *Dirty infected (part oftreatment)
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ANTIBIOTIC PROPHYLAXIS IN
SURGERY When ?
What ?
How many doses ?
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When?
Administration of prophylaxis > 3hr
significant reduces its effectiveness
( level 1a)
Ideally within 30 min of induction of aneth
For CS with clamp of cord
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WHAT TO GIVE ??
Procedure antibiotic dosage
Vaginal or
Abdominalhysterectomy
Cefazolin
Mertronidazol
2 g iv single
dose500 mg iv single
dos
laparoscopy None
Cesarean section Cefazolin 1g iv single dose
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How many doses ?
*During Surgery:Additional doses during the operationInsufficient evidence
(The impact of intra operative bleeding &fluid replacement on serumdrug conc. is negligible)
level2BThe individual surgeon free to give, extra dose for prolong operation,
or blood loss
Total:
1)one preoperative
2)one preoperative and two post operative3)mutilple doses
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Antibiotic prophylaxis for C/S
To give or not to give
(Cochrane Review) Randomized trial comparing antibiotic
prophylaxis or no treatment for both elective&emergency CS
81 trials, use of antibiotic reduce the incidence ofepisodes of fever ,endometritis ,uti.
*Wound infection reduce with antibiotic:
elective CS RR 0.73 (95% CI 0.53-0.99)
Em CS RR 0.36( 95% CI 0.26-0.51) For all patient RR 0.41(95% CI 0.29-0.43)
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Single dose versus multiple
dose prophylactic antibiotic
Randomized trial of one versus three doses of Augmentin aswound prophylaxis
Wound infection with one dose 10.7% compared with thosegive three doses 10.9%
postgrad Med J 1992
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Treatment of wound infection
Open the wound
Evacuate the pus
Cleansing the wound
Dressing the wound
Swab for c/s Use antibiotics
Close the wound
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Dressing of the wound
Normal saline
Hydrogen peroxide
Non- adherent ,absorbent dressing
honey
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Choice of antibiotic
1-post operative wound infection without sepsis (no GIT,FGT)
*Keflex 500mg po q6 h
*Augmentin 500 mg po q8 h
*Dicloxacillin 500 mg po q6 h
+/-
*Ciprofloxacin 500 mg po q12 h
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Choice of antibiotic
2) Post. Op. wound infection with sepsis (surgeryinvolving GIT,FGT)
*Cefoxitin 1gm iv q6h or
*Timentin 3.1gm iv q6h*Cefotaxime 1gm iv q 8 h,
*Ceftriaxone 1-2 gm iv q 24 h
+
*flagyl iv q8h or imipenum 500 mg iv q6 h
curr infect rep.2000oct
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Wound closure
Wound with minimal contamination, controlled bleeding,adequate detriments ,no foreign body may closed primarily
Closed wound with minimum tension
Delayed primary closure can be perform
after several days of dressing