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88 Cards in this Set
- Front
- Back
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What is the definition of contamination?
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The INTRODUCTION of organisms into a wound
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How common is contamination? Infection?
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Contamination Happens all the time, but infection is prevented more often
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What is the definition of infection?
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The ESTABLISHMENT of organisms in a wound and subsequent host reaction
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What is the definition of bacteremia?
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The presence of bacteria in the blood
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What is the definition of sepsis/ septicemia?
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The presence of sufficient bacteria in the blood causing illness
*Needs host immune response |
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What is the definition of endotoxemia?
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The presence of endotoxins in blood and resulting illness
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What is the definition of a surgical site infection?
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Infection of incision, tissues surrounding the incision, adjacent organ or viscous
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How is a complication different from a surgical site infection?
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Complications are distant infections
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What are the 3 classifications of surgical site infections?
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1) Superficial incisional SSI
2) Deep incisional SSI 3) Organ or space SSI |
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What is the rate of occurrence of surgical site infections in SA surgery? LA surgery?
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SA: 5.5%
LA: 7% in LA elective abdominal surgery |
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What are 3 ways that surgical site infection affects the outcome of surgery?
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1) Increased postoperative morbidity/ mortality
2) Increased cost of therapy 3) Prolonged hospitalization |
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What are 6 ways of reducing the incidence of surgical site infection?
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1) High standards of aseptic technique
2) Appropriate/ judicious use of antibiotics 3) Appropriate preoperative planning 4) Good case selection 5) Excellent surgical technique 6) Proper postoperative care |
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What are 5 host factors that increase the risk of post-op infections?
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1) Decreased immune competence
2) Prior irradiation of the surgical site 3) Older age of the animals (SA > 8 years) 4) Distant sites of active infection e.g. purulent drainage from a wound distant from surgical site 5) Abnormal body condition scores |
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When should surgery sites be clipped, before or after anesthetic induction? Why?
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Surgery sites are clipped after induction, if clipped before anesthetic induction then animals are 3X more likely to develop infection
-superficial skin infections from clipper abrasions and cuts |
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What are 3 factors before surgery (other than time of clipping) that can affect the chances of developing surgical site infection?
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1) Inadequate skin preparation of the surgical site
2) Duration of anesthesia >60 minutes 3) Administration of propofol as part of anesthetic protocol |
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How does using propofol as an anesthetic affect the chances of developing postop wound infections in a clean procedure?
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Using Propofol animals are 3.8x more likely to develop post-op infection
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Why can propofol increase the chances of infection?
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It's a lipid-based emulsion that supports rapid microbial growth secondary to external contamination
-Administration of contaminated solution causes temporary bacteremia |
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What is the critical level of contamination that results in surgical site infection?
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>10^5 organisms/gram of tissue
-influenced by pathogenicity and virulence -Fewer needed if foreign body present |
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A surgery > ______ minutes puts the patient at an increased risk of surgical site infection.
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> 90 minutes
-exact mechanism unclear: recolonization of prepped area more tissue damage greater depression of host defenses |
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What type of suture material puts the patient at an increased risk of surgical site infection?
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Braided/multifilament suture material
-Bacteria can hide in the interstices of the suture--> biofilm production -1 braided silk suture reduces the number of S. aureus organisms required to 10^2 |
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Why does the presence of any foreign material (implants!) prolong healing?
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Prolongs inflammatory phase of wound healing
-Inhibit normal defense mechanisms |
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What are 5 factors during surgery that can cause inhibition of normal host defenses?
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1) Blood clots
-Bacteria love to live in blood 2) Ischemic tissue -anaerobes 3) Charred tissue -Use electrosurgery sparingly 4) Fluid pockets 5) Foreign material |
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What are 3 ways to decrease contamination prior to surgery?
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1) Wear gloves
2) Cover open wounds w/ sterile dressings while you stabilize the animal 3) Clean equipment and instrumentation regularly |
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What are 8 ways to decrease contamination in surgery?
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1) Copious saline lavage
2) Debride wounds 3) Anatomical tissue apposition 4) Use surgical drains where needed 5) Proper suture selection 6) Closure of dead space 7) Judicious hemostasis -discriminate use of electrocautery 8) Gentle tissue handling -HALSTED'S PRINCIPLES |
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What is the definition of antimicrobial prophylaxis (W/ regards to surgery)?
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Administration of antimicrobial agent prior to surgical incision
-Beta lactams: penicllin, cephalosporins |
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The recommendations for administration of antimicrobial prophylaxis is based up the ________ system.
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National research Council Wound Classification System
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How does the National Research Council Wound Classification system categorize wounds?
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Based on the extent of operative contamination
-Antibiotic prophylaxis according to classification |
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What is the main criticism of the National Research Wound Classification system?
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Too broad
No risk stratification within groups (confounding risk factors identified) |
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The wound classification system has poor association with SSI and what equine surgery?
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Poor association w/ Equine abdominal sx
-Better association w/ SSI in equine orthopedic sx |
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What is a "clean" wound according to the wound classification system?
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Non-traumatic surgical wound
No breaks in aseptic technique e.g. castration, OVH- only trauma tissue experiences is you cutting into it and handling it |
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What is a "clean-contaminated" wound according to the wound classification system?
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Sx on respiratory, GI, U/G tracts w/o major spillage
Minor break in aseptic technique e.g. spay where touch something non-sterile and have to change gloves= minor break in aseptic technique |
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What is a "contaminated" wound according to the wound classification system?
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Gross spillage from viscous organ
Open wound <6 hours old Major break in aseptic technique |
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What is a "dirty" wound according to the wound classification system?
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Abscess, infected tissues encountered
Open wound > 6 hours old |
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What are 2 controversies recording the use of antimicrobials for clean surgery?
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Technically not warranted
Increased infection rate w/ antibiotic therapy longer than 24 h peri-op!!! |
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Antimicrobial prophylaxis is only recommended for what type of surgeries?
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Clean contaminated and selected contaminated surgeries
-lacerations < 6 h old |
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What type of antimicrobial use should be used for contaminated/ dirty surgeries?
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Antimicrobial therapy
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When is antimicrobial prophylaxis used for clean procedures?
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When the infection would be catastrophic to the outcome of the procedures
-Total hip replacement -Pacemaker -Any surgery > 90 minutes |
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Do you use antimicrobial prophylaxis for implants?
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Yes, they act as foreign bodies, also have to continue antibiotics
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What are 2 concentration dependent drugs used for antimicrobial prophylaxis? What does this mean?
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Aminoglycosides
fluoroquinolones -Successful therapy depends on the peak concentration above the MiC achieved during therapy |
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What are time dependent drugs? What's an example?
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Successful therapy depends on the time spent above MiC during therapy
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The choice of antimicrobial for perioperative prophylaxis has to do with what 2 factors?
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1) Empirical choice
-Aimed at EXPECTED CONTAMINATING BACTERIA 2) Ideal characteristics |
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What are the 4 ideal characteristics that need to be considered when deciding on a perioperative prophylaxis?
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1) Bactericidal
2) Low toxicity/ minimal side effects 3) Cost effective 4) Parenterally administered -more reliable plasma concentrations |
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What are 2 procedures that cephalosporins are used for in small animal surgery?
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1) Orthopedics
-Skin contamination -Staphylococcus -First generation cephalosporin 2) Soft tissue -Enteric bacteira -Second generation cephalosporin |
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What are 4 antimicrobials used in equine surgery?
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1) Potassium penicillin
2) Gentamicin 3) Ceftiofur 4) Concurrent NSAID use -Renal an GI toxicity issues |
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What are 2 antimicrobials used in foals?
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1) Cefazolin or ampicillin
-in times of K-penicillin shortage.. 2) Amikacin |
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What antimicrobial should not be used in young animals? Why?
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Enrofloxacin (fluoroquinolone)
-Cartilage damage in young animals |
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True or false. Ceftiofur can be used in production animal surgery.
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False, NOT ANYMORE
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What are 2 antimicrobials that can be used in production animal surgery?
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1) Penicillin
2) tetracycline -will cause enamel discoloration |
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When should antimicrobial prophylaxis be administered?
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At least 30 minutes prior to surgical incision but no longer than 60 minutes
-Want adequate TISSUE concentration at time of incision |
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When do the peak serum and surgical wound fluid concentrations equilibrate?
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Approximately 30 minutes after administration and then rapidly decline after that
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The choice of antimicrobial for perioperative prophylaxis has to do with what 2 factors?
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1) Empirical choice
-Aimed at EXPECTED CONTAMINATING BACTERIA 2) Ideal characteristics |
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What are the 4 ideal characteristics that need to be considered when deciding on a perioperative prophylaxis?
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1) Bactericidal
2) Low toxicity/ minimal side effects 3) Cost effective 4) Parenterally administered -more reliable plasma concentrations |
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What are 2 procedures that cephalosporins are used for in small animal surgery?
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1) Orthopedics
-Skin contamination -Staphylococcus -First generation cephalosporin 2) Soft tissue -Enteric bacteira -Second generation cephalosporin |
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What are 4 antimicrobials used in equine surgery?
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1) Potassium penicillin
2) Gentamicin 3) Ceftiofur 4) Concurrent NSAID use -Renal an GI toxicity issues |
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What are 2 antimicrobials used in foals?
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1) Cefazolin or ampicillin
-in times of K-penicillin shortage.. 2) Amikacin |
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What antimicrobial should not be used in young animals? Why?
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Enrofloxacin (fluoroquinolone)
-Cartilage damage in young animals |
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True or false. Ceftiofur can be used in production animal surgery.
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False, NOT ANYMORE
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What are 3 antimicrobials that can be used in production animal surgery?
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1) Penicillin
2) tetracycline -will cause enamel discoloration |
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When should antimicrobial prophylaxis be administered?
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At least 30 minutes prior to surgical incision but no longer than 60 minutes
-Want adequate TISSUE concentration at time of incision |
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When do the peak serum and surgical wound fluid concentrations equilibrate?
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Approximately 30 minutes after administration and then rapidly decline after that
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When do you stop the administration of antimicrobial prophylaxis?
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At end of surgery (SA)
-up to 24 h in equine -Up to 3 days post-op on equine colics -Sometimes intra-operative in cattle |
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What are 7 ways that antimicrobial failure can occur?
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1) Inappropriate antimicrobial selection
2) Dosing errors -too little -too late 3) Lack of delivery to affected site 4) Bacterial resistance 5) Polymicrobial infection 6) Implant- associated conditions 7) Misdiagnosis of noninfectious cuse |
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What is the incidence of surgical site infection in clean/clean-contaminated surgery? Contaminated? Dirty?
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-Clean/clean contaminated: 5% (SA)
-Contaminated: 12% (SA) -Dirty: 10.1% (SA) |
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How long does it take infection to develop with soft tissue procedures? Orthopedic procedures?
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Soft tissue: Within 30 days
Orthopedic procedure: w/in 1 year if an implant is placed |
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What are the 5 classical signs of acute inflammation?
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1) Pain
2) Heat 3) Redness 4) Swelling 5) Loss of function |
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What are 5 ways to detect surgical site infections?
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1) seeing the 5 classic signs of acute inflammation
2) Purulent discharge from a surgical incision 3) Deep/organ abscessation 4) Dehiscence 5) Microbial isolation |
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What are the 4 systemic signs of surgical site infection?
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1) **fever
2) Depression 3) Inappetence 4) Limb or organ dysfunction |
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What are 4 laboratory data that indicates surgical site infection?
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1) Leukocytosis (SA)
2) Degenerative left shit (SA) 3) Anemia 4) Elevated fibrinogen |
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What are 5 radiographic signs of surgical site infection?
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1) Mixed pattern
-Lysis & proliferation 2) Abscessation 3) Implant failures 4) Increased fluid density 5) Soft tissue swelling |
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What are 2 types of cytology and staining that can help diagnose surgical site infection?
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1) Abdominocentesis
2) Aspiration of surgical site |
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What should you do with a deep needle aspirate or biopsy to diagnose a surgical site infection?
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Cytology and gram staining
Culture and sensitivity |
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True or false. Surface contaminants of a wound are usually representative of infective organisms.
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False, NOT usually representative of infective organisms
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What are the 2 common skin contaminants involved in small animal orthopedic surgery?
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1) Coagulase + staphylococcus spp.
2) Beta-hemolytic streptococcus spp. |
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What are the 2 bacteria involved with soft tissue surgical site infections?
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Enterics:
-E. coli -Klebsiella |
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What are 3 other common bacteria in small animal surgery (not specific to orthopedics or soft tissue)?
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1) Pasteurella multocida
2) Pseudomonas aeruginosa 3) Bacteroides |
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What are the 5 main bacteria involved with surgical site infection with equine surgery?
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1) Staphylococcus spp
2) Enterobacteriaceae 3) Streptococcus spp 4) Pseudomonas aeruginosa 5) Anaerobes |
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What are 3 things you can do in addition to appropriate antibiotic therapy to treat a surgical site infection?
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1) Wound debridement
2) Surgical drainage 3) Implant removal |
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What are 3 things that help select the antimicrobial for surgical site infections?
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1) empirical
2) Culture and sensitivity results 3) Cytology and gram stain |
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Where are anaerobic infections of surgical sites commonly found?
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In areas with mucosal surfaces:
-Oral cavity -GIT (anaerobic bacteria outnumber the aerobic) Other common sites: -abscesses -Chronic draining tracts |
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What are 4 less common sites of anaerobic infections of surgical sites?
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1) Pleural cavity
2) Bones 3) Respiratory tract 4) Abdominal cavity |
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More than 70% of obligate anaerobes are caused by what specie of bacteria?
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Bacteroides species
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What are the 4 facultative aerobic bacteria that make up 80% of anaerobic infections?
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1) E. coli* most common
2) Enterobacteriaceae 3) Pasteurella species 4) Staphylococcus intermedius |
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How do anaerobic and aerobic bacteria have a synergistic relationship?
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Aerobes use up the oxygen to make better conditions for the anaerobic bacteria
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Anaerobic infections should be treated empirically based on what 3 things?
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1) Clinical signs
2) Malodor 3) Cytology and gram staining |
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What are 5 drug choices for anaerobic infection from surgery?
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1) Amoxicillin-clavulonic acid
2) Metronidazole 3) Chloramphenicol 4) Ampicillin 5) Clindamycin |
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What is the definition of nosocomial infection?
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Infections not present or incubating at time of admission
-Develop during or after hospitalization |
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What are 4 common causes of nosocomial infection?
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1) MRSA
2) Salmonella 3) Gram negatives 4) viruses |
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What are 7 risk factors for developing nosocomial infection?
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1) Breaks in aseptic or disinfecting techniques
2) Prolonged hospitalization -Boarding! 3) Recumbency 4) Catheters 5) Direct contamination of wounds and bandages 6) Excessive use (Misuse) of antibiotics 7) Unclean hospital environment *WE CAN INFLUENCE THESE |
