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MANAGEMENT OF POST 
OPERATIVE WOUND INFECTION 
(SURGICAL SITE INFECTION) 
DR BASHIR YUNUS 
20/11/14 
bbinyunus2002@gmail.c...
 INTRODUCTION 
 DEFINITION 
 EPIDIMIOLOGY 
 CLASSIFICATION 
 PATHOGENESIS 
 RISK FACTORS 
 MICROBIOLOGY 
 MANAGEME...
INTRODUCTION 
 It is defined as infection present in any location along 
the surgical tract after a surgical procedure wi...
INTRODUCTION 
 Incidence vary from center to center. 
 About 2-5% develop SSI in US accounting for about 
300,000-500,00...
INTRODUCTION 
 CLASSIFICATION 
 INCISIONAL 
 Superficial (skin and subcutaneous ) 
 Deep (fascia and muscle) 
 ORGAN/...
 CRITERIA 
INTRODUCTION 
 The above classification, each class is accompanied by at 
least one of the following; 
 Puru...
bbinyunus2002@gmail.com 7 11/23/2014
INTRODUCTION 
 RISK FACTORS 
 GENERAL/ PATIENT FACTORS 
 LOCAL FACTORS 
 MICROBIAL FACTORS 
bbinyunus2002@gmail.com 8 ...
 PATIENT FACTORS 
 Age; elderly 
 malnutrition 
 Obesity 
 DM 
 Malignancy 
 Prolonged steroid use 
 Immunosuppres...
 LOCAL FACTORS 
 Poor skin preparation 
 Bridge of asepsis 
 Contaminated instrument 
 Prolong procedure(>2hrs) 
 Po...
 MICROBIAL FACTOR 
 Virulence 
 Bacterial resistance 
 Dose of inoculum 
 Pre-existing remote body site infection 
bb...
MICRO-ORGANISMS 
 Depends on the type of surgical procedure 
 Clean : staph aureus (commonest) 
 Exogenous source 
 Sk...
 History 
MANAGEMENT 
 Pain, fever, discharge usually about 5th day post 
operatively (5-7days) 
 However, infection ca...
MANAGEMENT 
 Physical examination 
 GPE 
 Wasted 
 Obese 
 febrile 
 Anaemic 
 Dehydrated 
 Pedal oedema 
bbinyunu...
 Systemic 
MANAGEMENT 
 Systemic involvement- septicemia 
 Pre-existing remote infection 
 LOCAL 
 Oedema 
 Hyperami...
INVESTIGATION 
 WOUND SWAB MCS 
 WOUND BIOPSY 
 FBC- leukocytosis, or leukopenia 
 U/Ecr – hyponatremia in necrotising...
Treatment 
 Sutures in the infected part are removed for free drainage 
of pus, expressed 
 Wound swab is taken for MCS ...
PREVENTION 
 It is better prevented than treated 
 Prevention starts pre-operatively, intra and post-operatively 
bbinyu...
PREVENTION 
 PRE-OPERATIVE 
 Short pre-operative hospital stay 
 Pre-op antiseptic shower 
 Pre-op hair removal 
 Pre...
PREVENTION 
 INTRA-OPERATIVE 
 Strict asepsis 
 Skin preparation 
 Gowning and draping 
 Good surgical technique 
 D...
PREVENTION 
 POST-OPERATIVE 
 Protect wound for 1st 48hrs then inspect, however if 
dressing is soaked, change dressing....
COMPLICATIONS 
 Abscess 
 Septicemia 
 Sinus 
 Synergistic gangrene 
 Wound dehiscence 
 Weak and ugly scar 
bbinyun...
CONCLUSION 
 SSI is a common preventable post operative 
complication which prolong hospital stay, hence cost 
medical ca...
REFERENCES 
 E.A. Badoe, E.Q. Arcampompong, J.T Rocha; “Principles and Practice of 
surgery including pathology in the tr...
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Management of post operative wound infection

post operative wound infection now surgical site infection is a common post operative complication especially in developing countries and the 2nd most common nosocomial infection. it leads to prolong hospital stay among other complications

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Management of post operative wound infection

  1. 1. MANAGEMENT OF POST OPERATIVE WOUND INFECTION (SURGICAL SITE INFECTION) DR BASHIR YUNUS 20/11/14 bbinyunus2002@gmail.com 1 11/23/2014
  2. 2.  INTRODUCTION  DEFINITION  EPIDIMIOLOGY  CLASSIFICATION  PATHOGENESIS  RISK FACTORS  MICROBIOLOGY  MANAGEMENT  HISTORY  PHYSICAL EXAMINATION  INVESTIGATION  TREATMENT  PREVENTION  CONCLUSION  REFERENCES OUTLINE bbinyunus2002@gmail.com 2 11/23/2014
  3. 3. INTRODUCTION  It is defined as infection present in any location along the surgical tract after a surgical procedure within 30days of procedure or up to 1 year after a procedure that has involved an implant. bbinyunus2002@gmail.com 3 11/23/2014
  4. 4. INTRODUCTION  Incidence vary from center to center.  About 2-5% develop SSI in US accounting for about 300,000-500,000 patient per annum  2nd most common type of Hospital Associated infection. bbinyunus2002@gmail.com 4 11/23/2014
  5. 5. INTRODUCTION  CLASSIFICATION  INCISIONAL  Superficial (skin and subcutaneous )  Deep (fascia and muscle)  ORGAN/SPACE  Involves any part of anatomy in organs and spaces other than the incision which was opened or manipulated during operation. bbinyunus2002@gmail.com 5 11/23/2014
  6. 6.  CRITERIA INTRODUCTION  The above classification, each class is accompanied by at least one of the following;  Purulent discharge with or without laboratory confirmation.  Organism isolated from aseptically obtained culture  At least one of the signs of inflammation  Spontaneous wound dehiscence or delibrate opening by the attending surgeon  Diagnosis by the attending surgeon bbinyunus2002@gmail.com 6 11/23/2014
  7. 7. bbinyunus2002@gmail.com 7 11/23/2014
  8. 8. INTRODUCTION  RISK FACTORS  GENERAL/ PATIENT FACTORS  LOCAL FACTORS  MICROBIAL FACTORS bbinyunus2002@gmail.com 8 11/23/2014
  9. 9.  PATIENT FACTORS  Age; elderly  malnutrition  Obesity  DM  Malignancy  Prolonged steroid use  Immunosuppressive diseases  Anaemia  Chronic inflammatory diseases bbinyunus2002@gmail.com 9 11/23/2014
  10. 10.  LOCAL FACTORS  Poor skin preparation  Bridge of asepsis  Contaminated instrument  Prolong procedure(>2hrs)  Poor surgical technique  Operation on an infected organ: TIP, perforated appendicitis  Foreign body  Local tissue necrosis bbinyunus2002@gmail.com 10 11/23/2014
  11. 11.  MICROBIAL FACTOR  Virulence  Bacterial resistance  Dose of inoculum  Pre-existing remote body site infection bbinyunus2002@gmail.com 11 11/23/2014
  12. 12. MICRO-ORGANISMS  Depends on the type of surgical procedure  Clean : staph aureus (commonest)  Exogenous source  Skin flora  Clean-contaminated, contaminated and dirty wound : polymicrobial- anaerobes and aerobes  E. coli  Proteus  Psedomonas  bacteroides bbinyunus2002@gmail.com 12 11/23/2014
  13. 13.  History MANAGEMENT  Pain, fever, discharge usually about 5th day post operatively (5-7days)  However, infection can be seen within 48hours(within 6- 8hrs) with organisms such as clostridium, bacteriodes, β- hemolytic streptococcus and coliforms.  History of risk factors as mentioned,co-morbidities. bbinyunus2002@gmail.com 13 11/23/2014
  14. 14. MANAGEMENT  Physical examination  GPE  Wasted  Obese  febrile  Anaemic  Dehydrated  Pedal oedema bbinyunus2002@gmail.com 14 11/23/2014
  15. 15.  Systemic MANAGEMENT  Systemic involvement- septicemia  Pre-existing remote infection  LOCAL  Oedema  Hyperamia  Discharge  Gapping wound edges  tenderness bbinyunus2002@gmail.com 15 11/23/2014
  16. 16. INVESTIGATION  WOUND SWAB MCS  WOUND BIOPSY  FBC- leukocytosis, or leukopenia  U/Ecr – hyponatremia in necrotising fasciitis  USS- intra abdominal uss  CTSCAN bbinyunus2002@gmail.com 16 11/23/2014
  17. 17. Treatment  Sutures in the infected part are removed for free drainage of pus, expressed  Wound swab is taken for MCS (other investigations are requested base on the assessment of the attending surgeon) FBC, U/E, USS, serum protein, wound biopsy-mcs  Placed on broad spectrum antibiotics pending the result of mcs  Wound dressing(frequency depends on degree of infection) and debridement of necrotic tissues.  Correction of anaemia if present other derangements bbinyunus2002@gmail.com 17 11/23/2014
  18. 18. PREVENTION  It is better prevented than treated  Prevention starts pre-operatively, intra and post-operatively bbinyunus2002@gmail.com 18 11/23/2014
  19. 19. PREVENTION  PRE-OPERATIVE  Short pre-operative hospital stay  Pre-op antiseptic shower  Pre-op hair removal  Pre-op bowel preparation  Pre-op antibiotics  Tight glucose control  Optimize nutrition  Stop smoking bbinyunus2002@gmail.com 19 11/23/2014
  20. 20. PREVENTION  INTRA-OPERATIVE  Strict asepsis  Skin preparation  Gowning and draping  Good surgical technique  Dead space  Appropriate sutures  Debridement  Approximate not strangulate  Justify use of drain  Delay primary closure when indicated  Supplemental O₂, adequte fluid resuscitation, bbinyunus2002@gmail.com 20 11/23/2014
  21. 21. PREVENTION  POST-OPERATIVE  Protect wound for 1st 48hrs then inspect, however if dressing is soaked, change dressing.  Early enteral nutrition  Tight glucose control  Surveillance programme bbinyunus2002@gmail.com 21 11/23/2014
  22. 22. COMPLICATIONS  Abscess  Septicemia  Sinus  Synergistic gangrene  Wound dehiscence  Weak and ugly scar bbinyunus2002@gmail.com 22 11/23/2014
  23. 23. CONCLUSION  SSI is a common preventable post operative complication which prolong hospital stay, hence cost medical care as well as other complications.  Risk factors should taken into consideration for appropriate prevention and prompt treatment went it occur. bbinyunus2002@gmail.com 23 11/23/2014
  24. 24. REFERENCES  E.A. Badoe, E.Q. Arcampompong, J.T Rocha; “Principles and Practice of surgery including pathology in the tropics”. 4th edition, Assembly of God Literature Center ltd 237-238  F Charles et tal “schwart’s principles of surgery” tenth edition, Mc Graw Hill Education.  www.wikipedia.com  www.slideshare.net bbinyunus2002@gmail.com 24 11/23/2014

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