Presentation on theme: "Surgical infection Presented by Dr Azza Serry. definition Contamination is mere presence of micro- organisms in the wounds,when these organisms invade."— Presentation transcript:
Surgical infection Presented by Dr Azza Serry
definition Contamination is mere presence of micro- organisms in the wounds,when these organisms invade the tissues and produce ill effects,this is called infection.
Bacteriology Staphylococci : gram positive live in skin and nostril Live in skin and nostril Gives rise to pustules,,abcesses,surgical wound infection and pneumonia and pneumonia. Streptococci : gram positive, haemolytic and non haemolytic Haemolytic : live in nasopharynx, cause spreading infection as cellulitis, lymphangitis Non haemolytic : found in mouth and bowel, cause minor infection,dental abscess
Gram positive and gram negative bacteria
Aerobic gram negative bacilli Escherichia coli (E.coli) : Found in intestinal tract Cause urinary tract infection Pseudomonas : Found in respiratory tract Infect open wounds and burns
Anaerobic bacteria Peptostreptococci and gram negative bacilli ( bacteroids ) Found in skin and mucous membrane Cause wound infection, abscess (gas forming,foul smelling discharge ),and septicaemia
Non specific surgical infection surgical site infection Types of surgical wounds Clean : 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.
Clinical picture Appears between 5 th - 10 th post operative days Swollen red painful wound, fever Fluctuation or crepitus may be felt
prophylaxis Patient : control diabetes shave hairy areas just before skin incision skin preparation with proper antiseptics Surgeon : proper scrubing proper hemostasis Prophylactic antibiotics
Treatment Remove stiches, keep wound open to allow free exit of pus Antibiotics are used according to culture and sensitivity
Acute abscess Localized suppurative inflammation Staphylococci is commonest cause Presents by : pain,tender mass,covering skin is red,oedematous, headache, fever enlarged tender draining lymph nodes When pus is formed, pain becomes throbbing, hectic fever, Treatment : before suppuration, antibiotics,hot application,rest after suppuration, incision and drainage
Specific surgical infection Tetanus : anaerobic infection caused by neurotoxin of clostridium tetani leads to nervous irritability and muscular contraction Clostridium tetani : gram positive anaerobic bacilli. mode of infection : wounds contaminated with soil or feces tetanus neonatorum : infected umbilical stump
Clinical picture Incubation period : 2 weeks,fever,tachycardia, wound appear inflamed Tonic stage :neck stiffness bitter smile lock jaw Clonic stage : minor stimuli → severe muscular contractions incomplete relaxation in between. back is arched backwards respiratory insufficiency high temperature
prevention Immunization: active - passive Active : tetanus toxoid during childhood at 2,4, 6 months followed by booster dose at 18 months and school age Immunization repeated every years,and at time of injury Passive : injection of antitetanic globulin
treatment Antitetanic globulin Wound is left open and remove foreign bodies and dead tissues Proper sedation Antibiotics, penicillin Tracheostomy or mechaniacal ventilation severe cases Patient should be isolated in dark room, nasogastric feeding.