wound infection 2

8/14/2019 Wound Infection 2

1/24

Wound Infection

Dr. Nisreen Anfanan

Dr .T.Zamzami


2/24

Definition of Wound InfectionDefinition of Wound Infection

SuperficialSuperficial

Involve skin&sc tissueInvolve skin&sc tissue

Deep( Narcotizing Falsities)Deep( Narcotizing Falsities)


3/24

Incidence of wound infectionSite Incidence

International 5-34 %

USA

14-16 %

KKUH for CS 4.5 %

KAUH ??


4/24

Surgical Operation Classification

Clean < 2 %

Clean-contaminated


5/24

Wound Healing

*Inflamation

vascular

cellular*Epithalisation

*Fibroplasia

*Wound contraction


6/24

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


7/24

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


8/24

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


9/24

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)


10/24

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)


11/24

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


12/24

Prevention

4) ANTIBIOTIC PROPHYLAXIS IN SURGERY

*Choice of antibiotic

*Comprehensive risk assessment for chooseof antibiotic

*Clean procedures ( issue of

debate) *Dirty infected (part oftreatment)


13/24

ANTIBIOTIC PROPHYLAXIS IN

SURGERY When ?

What ?

How many doses ?


14/24

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


15/24

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


16/24

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


17/24

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)


18/24


19/24

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


20/24

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


21/24

Dressing of the wound

Normal saline

Hydrogen peroxide

Non- adherent ,absorbent dressing

honey


22/24

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


23/24

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


24/24

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

wound infection 2

Documents