Surgical Infection.ppt

Surgical Infection John Pender, MD BSOM, East Carolina University April 1, 2005 SSI Superficial Deep Organ/space 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. SSI 1992 $3,152 in extra charges 1980 extra ten days of hospitalization 12%-84% present after discharge Most present within 21 days Risk factors for SSI Diabetes Nicotine Steroids Malnutrition Length of preoperative hospitalization Nares colonization Staph Aureus Perioperative transfusion 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 Antimicrobrial prophylaxis Clean contaminated procedures Vascular cases Cardiac cases Orthopedic prosthetic cases Second generation cephalosporin for distal intestinal tract Timing Class I (clean) Atraumatic wound w/o inflammation. No respiratory, GU,GI,or biliary tract entered Hernia repair ? infection rate Class I (clean) Atraumatic wound w/o inflammation. No respiratory, GU,GI,or biliary tract entered Hernia repair 1.5% infection rate Class II(clean/contaminated) Controlled entrance into respiratory, GU,GI,or biliary tracts Cholecytectomy, elective bowel resection ? infection rate Class II(clean/contaminated) Controlled entrance into respiratory, GU,GI,or biliary tracts Cholecytectomy, elective bowel resection 7.5% infection rate Class III(contaminated) Traumatic wounds, major breaks in sterile techniques, gross spillage of GI contents, Acute non-purulent inflammation Appendectomy ? infection rate Class III(contaminated) Traumatic wounds, major breaks in sterile techniques, gross spillage of GI contents, Acute non-purulent inflammation Appendectomy 15% infection rate Class IV (dirty) Old trau