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HISTORICAL BACKGROUND
Reducing the mortality associated with surgery : Preventing microbial penetration Reducing the microbial inoculum Treating established infection
Pathophysiology of infection
Three factor must be exist : 1. An inoculum of pathogens Sufficient number Virulence 2. A nutrient medium on which microbes can thrive 3. Some alteration in host resistance must accur
Host Defenses
Host defenses are important in preventing mikrobial penetration into the tissue lokal host defenses tissue are protected from microbal invasion by a layer of epithelium systemic host defenses consist of phagositic cells, the imun system,complement system, coagulation and the kinin system
Surgical Infection
Infections that require operative treatment Infections that result from operative treatment
peritonitis, supurative pericarditis, empyema 3. tissue, organ and joint infections abscess, septic arthritis 4. Prosthetic device-associated infections
1. 2. 3.
4.
The development of surgical infection depends on: Microbial pathogenicity and number Host defences the local environtment Surgical technique
Microbial pathogenicity some mikrobes have virtually no ability to cause infection in normal host can cause lethal infection in an individual with compromised host defense
Host defenses are important in preventing mikrobial penetration into the tissue lokal host defenses tissue are protected from microbal invasion by a layer of epithelium systemic host defenses consist of phagositic cells, the imun system,complement system, coagulation and the kinin system
Local environmental factors may permit an infection to occur in a person with minimal microbial contamination & with otherwise adequate host defense A suture can reduce the number os S.aureus Fluid collection & edema infection , cause inhibit fagositosis
Surgical technique surgeon can reduce likelihood infection: handling tissue gently removing devitalized tissue, blood,etc using drain appropriately
Type of Surgical Infections 1. Soft tissue infections Cellulitis and Lymphangitis soft tissue abscess necroting soft tissue infection Tetanus 2. Body cavity infection Peritonitis and intrabdominal Empyema
Cellulitis & Lymphangitis spreading infection of the skin and subcutaneus tissue caused by Strep. Pyogenes, S.aureus, Strep.pneumonia, H.influenzae and aerobic and anaerobic gram negative bacteria
Soft tissue abscess -> mostly found on the back -> most common cause by Stap.aureus
Necrotizing soft tissue infections most caused by mixed aerobic and an aerobic gram negative and gram positive bacteria. Clostridium spesies
Peritonitis and intraabdominal abscess primary peritonitis caused by a single organism most common in young children and adults with ascites or CRF Secondary bacterial peritonitis ussualy the result of a defect in GIT Tertiary peritonitis peritonitis like synd. result of disturbance host immune response caused by fungi or low grade pathogenic bacteria
NOSOCOMIAL INFECTION
Definition Tranmission of pathogen organism to the patient no had infection before. Clasification of nosokomial infection Community based acquire infection Hospital based acquire infection Operating based room acquire infection
PATHOPHYSIOLOGY
The two key features contributing to the development of N.I
1. Reduction in the patients normal immune or defense systems 2. Colonizations by pathogenic or potentially pathogens
Wound classification
Wound Class Expected infection Rates 1,0 - 5,4 % 2,1 - 9,5 % 3,4 - 13,2 % 3,1 - 12,8 %
Superficial surgical Wound Infection An incisional wound infection occurs within 30 days after operation involves skin or subcutaneous tissue above the fascial layer & any of the following 1. There is purulent drainage from the incision or a drain located above the fascial layer. 2. An organism is isolated from culture of fluid that has been aseptically obtained from a wound that was closed primarily. 3. The wound is opened deliberately by the surgeon, unless the wound is culture-negative.
Deep surgical wound infection occurs within 30 days after operation, involves tissues or spaces at or beneath the fascial layer and any of the following 1. The wound spontaneously dehisces or is deliberately opened by the surgeon when the patient has a fever (>38C) and/or there is localized pain or tenderness, unless the wound is culture-negative. 2. An abscess or other evidence of infection directly under the incision is seen on direct examination, during operation, or by histopathologic examination. 3. The surgeon diagnoses infection.
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