Professional Documents
Culture Documents
@ The strategy for wound infection management is to
prevent or minimize the risk of infection.
@ An action or set of actions intentionally taken to reduce
the risk of SSI.
@ Reducing opportunities for microbial contamination of the
patient¶s tissues or sterile surgical environment.
@ Applied to the patient preparation, Surgical team
members educated in aseptic technique, care of Theatre
environment and instruments, optimize surgical
technique.
@ the Centers for Disease Control and Prevention (CDC)
and Healthcare Infection Control Practices Advisory
Committee (HICPAC) presents recommendations for the
prevention of surgical site infections (SSIs), formerly
called surgical wound infections.
x x
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@ Adequately control serum blood glucose levels .
@ Encourage tobacco cessation
@ Do not withhold necessary blood products from surgical patients as
a means to prevent SSI. .
@ Pre-operative shower or bathe with an antiseptic agent on at least
the night before the operative day
@ Thoroughly wash and clean at and around the incision site &Use an
appropriate antiseptic agent .
º
@ eep preoperative stay in hospital as short as possible while allowing for
adequate preoperative preparation of the patient.
@ Apply preoperative antiseptic skin preparation in concentric circles&The
prepared area must be large enough to extend the incision or create new
incisions or drain sites,
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@ Taper or discontinue systemic steroid use before elective surgery .
@ enhance nutritional support .
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º Shaving the surgical site with a razor
induces small skin lacerations:
@ Potential sites for infection.
@ Disturbs hair follicles which are often
colonized with
@ Risk greatest when done the night
before.
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@ Select an antimicrobial agent safe, inexpensive, and bactericidal
with efficacy against expected pathogen .
@ Administer IV& timed to achieve adequate bactericidal serum
levels during operation and for few hours after incision closed .
@ Before colorectal elective operations, in addition to IV
antimicrobial drugs, mechanically prepare the colon with
enemas and cathartic agents; administer nonabsorbable oral
antimicrobial agents in individual doses the day before surgery .
@ For cesarean sections in patients at high risk administer IV
antimicrobial agent immediately after cord is clamped.
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@ -Do not routinely use vancomycin for prophylaxis
Prophylactic Antibiotics
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Risk of nosocomial
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Preoperative circumstances
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@ Maintain positive pressure ventilation of the operating room.
@ eep operating room doors closed .
@ Maintain a minimum of 15 air changes per hour, with a
minimum of 3 being fresh air.
@ Appropriate filters should be used for filtration of all air
whether re circulated or fresh.
@ Air should enter through the ceiling and exit near the floor.
@ Prior to subsequent procedures, visibly soiled surfaces should
be cleaned with Environmental Protection Agency (EPA)±
approved disinfectants.
@ Following a contaminated or dirty procedure, special cleaning
or closure of the operating room is not necessary.
@ Sterile surgical instruments and solutes should be assembled
just prior to use.
@ Sterilize all surgical instruments according to published
guidelines.
@ Temperature should be maintained at 20°- 22°C with a
humidity of 30 ± 60 %.
º
@ 0imit the number of personnel entering the operating room.
@ Orthopedic implant surgery should be performed in an ultra
clean air environment & achieved by laminar air flow (particle
free air move over the aseptic operating field at a uniform
velocity)
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º Treating wound infections depends on the nature of the
wound, degree of infection, and the bacteria responsible
for the infection.
@
!
Remove sutures and staples local to the site of infection.
Skin and subquatenous tissues in involved area opened
& exam to assess its integrity and for a deep space
infection & to exclude the underlying fascial dehiscence.
Evacuate the pus.
Swab for c/s.
@
!by irrigating the wound with
sterile (clean) water or normal saline &It may be done
using high pressure with a needle or catheter and a large
syringe , ëerm-killing solutions may also be used to
clean the wound like Hydrogen peroxide.
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@ ! to clean and remove objects, dirt, or dead skin
and necrotic tissues from the wound area.
@
! to protect the wound from further
injury and infection. These may also help provide pressure to
decrease swelling. Dressings may come in different forms.
Dressing changes allow the tissues to granulate.
@
@
to fight the infections, patient high risk for
dissemination of infection (i.e. diabetics ; Immnuno-
compromised, if prosthetics involved, if patient has signs of
systemic toxicity or if surrounding area of soft tissue erythema
and edema.
@
booster shot may be indicated to prevent
the occurrence of tetanus.
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@ Restore breathing and blood circulation as soon as
possible after injury.
@ Warm the victim and at the earliest opportunity provide
high-energy nutrition and pain relief.
@ Do not use tourniquets.
@ Perform wound toilet and debridement as soon as
possible (within 8 hours if possible).
@ Respect universal precautions to avoid transmission of
infection.
@ ëive antibiotic prophylaxis to victims with deep wounds
and other indications.
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@ Wounds more than 6 hours before surgical
treatment of the wound or show one or more of the
following: a puncture-type wound, a significant
degree of devitalized tissue, clinical evidence of
sepsis, contamination with soil/feces likely to
contain tetanus organisms, burns, frostbite, and
high velocity missile injuries.