Presentation on theme: "Presented by Dr Azza Serry"— Presentation transcript:
1Presented by Dr Azza Serry Surgical infectionPresented by Dr Azza Serry
2definitionContamination is mere presence of micro- organisms in the wounds ,when these organisms invade the tissues and produce ill effects ,this is called infection .
3BacteriologyStaphylococci : gram positive live in skin and nostrilLive in skin and nostrilGives rise to pustules ,,abcesses ,surgical wound infection and pneumonia and pneumonia.Streptococci : gram positive , haemolytic and non haemolyticHaemolytic : live in nasopharynx , cause spreading infection as cellulitis , lymphangitisNon haemolytic : found in mouth and bowel , cause minor infection ,dental abscess
5Aerobic gram negative bacilli Escherichia coli (E .coli) :Found in intestinal tractCause urinary tract infectionPseudomonas :Found in respiratory tractInfect open wounds and burns
6Anaerobic bacteriaPeptostreptococci and gram negative bacilli ( bacteroids )Found in skin and mucous membraneCause wound infection , abscess (gas forming ,foul smelling discharge ) ,and septicaemia
7Non specific surgical infection surgical site infection Types of surgical woundsClean : elective non traumatic wounds , gastrointestinal or urinary is not entered .Clean contamination : elective gastrointestinal or urinary tracts .Contaminated : open accidental wounds encountered within 4 hours ,incision through inflamed , non purulent tissues .Dirty : traumatic wounds more than 4 hours ,purulent infection .
8Clinical picture Appears between 5th - 10th post operative days Swollen red painful wound , feverFluctuation or crepitus may be felt
9prophylaxis Surgeon : proper scrubing Prophylactic antibiotics Patient : control diabetesshave hairy areas just before skin incisionskin preparation with proper antisepticsSurgeon : proper scrubingproper hemostasisProphylactic antibiotics
10Treatment Remove stiches , keep wound open to allow free exit of pus Antibiotics are used according to culture and sensitivity
11Acute abscess Localized suppurative inflammation Staphylococci is commonest causePresents by : pain ,tender mass ,covering skin is red ,oedematous,headache , feverenlarged tender draining lymph nodesWhen pus is formed , pain becomes throbbing , hectic fever ,Treatment : before suppuration , antibiotics ,hot application ,restafter suppuration , incision and drainage
13Specific surgical infection Tetanus : anaerobic infection caused by neurotoxin of clostridium tetani leads to nervous irritability and muscular contractionClostridium tetani : gram positive anaerobic bacilli .mode of infection : wounds contaminated with soil or fecestetanus neonatorum : infected umbilical stump
14Tonic stage :neck stiffness Clinical pictureIncubation period : 2 weeks ,fever ,tachycardia,wound appear inflamedTonic stage :neck stiffnessbitter smilelock jawClonic stage : minor stimuli → severe muscular contractions incomplete relaxation in between .back is arched backwardsrespiratory insufficiencyhigh temperature
15prevention Immunization: active - passive Active : tetanus toxoid during childhood at 2 ,4 , 6 months followed by booster dose at 18 months and school ageImmunization repeated every years ,and at time of injuryPassive : injection of antitetanic globulin
16treatment Antitetanic globulin Wound is left open and remove foreign bodies and dead tissuesProper sedationAntibiotics , penicillinTracheostomy or mechaniacal ventilation severe casesPatient should be isolated in dark room , nasogastric feeding .