1. Prevention of Sepsis Handwashing Skin preparation Tissue Handling – Minimise trauma – Avoid damage to blood vessels Minimise blood loss Obliterate dead space Minimise foreign material Antibiotic prophylaxis

2. Surgical Drains Indications: – Prevent accumulation of fluid Blood Pus Infected fluids – Prevent accumulation of air/gas – Characterise fluid

3. Surgical Drains Types: – Open Simple (corrugated tubes or sheets) Can increase the risk of infection in non-infected cases – Closed Reduce the risk of infection – Passive Differential pressure or gravity – Active Suction - low or high pressure (Redivac) – Rubber Inflammatory - may encourage tract formation – Silastic Inert

4. Surgical Drains Types – Penrose Soft rubber tube Dependent Drainage - gravity Open – Jackson-Pratt Closed Collection bulb + low grade suction – Negative Pressure Wound Therapy Enclosed foam + suction Healing of large areas by granulation

5. Surgical Drains Practical Points – Drain must be secured (but removable) – Fluid drained must be measured (accurately) – Include fluid drained in fluid balance – Monitor changes in character of fluid drained

6. Surgical Drains Removal – Always use aseptic technique – As soon as possible The longer in situ, the greater the risk of infection – When drainage < 25 ml/day – Shortening - gradual removal Useful when draining part of the body that normally secrete fluid, e.g. peritoneum. – Analgesia may be needed – Send tip to lab. for culture, if available

7. Surgical Drains Evidence – Paucity Remember: No evidence of effect is NOT the same as evidence of no effect. – Not recommended in uninfected or uncomplicated cases. – In complex cases, understand the problem and the benefits to be gained by using a drain. – Remove as soon as possible when job done to avoid introducing infection.

8. Any Questions?

9. Bacteriology Samples Time of pyrexia Pre-antibiotics Sample taken properly (aseptic technique) Specimen to lab ASAP (particularly anaerobes) Swabs in transport media Label correctly

10. U.T.I. E. Coli69 Proteus mirabilis4.3 Klebsiella4.7 Enterococcus5.5 Staph spp4.0 Pseudomonas11 % General Population% Hospital Population