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describe the CDC classification of surgical infections

SSI = one that occurs anywhere within operative field after surgery1. incisional (superficial vs deep)2. organ/space


Wound/operative procedure classification guidelines by the national research council



percentage of clean elective ortho procedures that get infected

15%(generally higher than reported for a clean wound---2-4.8%)


risk factor for SSI and clipping surgical site

clip immediately prior to procedureanimals clipped within 4 hours of induction had an equally significant risk for SSI as those clipped >4 hr prior to inductioncolonizing "nicks"


risk factor for SSI and duration of sx

risk of SSI approximately doubles for every 60 minutes of surgery timesuppression of cell mediated immunity, exposure incr, more tissue handling


risk factor for SSI and duration of ax

30% increase in risk SSI for every 60 min of axpropofol use (lipid base)


risk factor for SSI and endocrinopathies

DM has not been incr risk for SSIDM has been incr risk for UTI and dermatologic dzSSI risk with Cushings, hypoT


risk factor for SSI and # people in OR

for ea additional person in OR, risk of SSI increases as much as 30%(1.3 x)


risk factor for SSI and sex/neuter status

intact male cats/dogs incr risk SSI


other misc. risk factors for SSI

immunosuppressive drugs (GCC, chemo)infxn elsewhere in bodyperiop hypotension, hypothermiapoor BCSsuture typeblood lossASA statushospital stay


range of reported SSI in veterinary patients

clean 2-4.8%clean contaminated 3.5-5.0%contaminated 4.6-12%dirty 6.7-18.1%


recommendations for period Ab prophylactic use

1. when risk of infxn is high (clean-contamin, contaminated, dirty)2. SSI would have disastrous consequences


Ab of choice for clean contaminated procedures of the skin and/or GI tract

cefazolincovers gm + and gm -- Enterococciminimal side effectscheap


timing of Ab administration

Ab should be in the tissue operative site at effective concentrations at start of surgeryconcentrations should be maintained. recommend at induction or within 1 hr of surgical incision and repeated every 2 hours (per TJ)


disadvantage of using perioperative Ab in cases where no significant benefit occurs

may contribute to colonization with resistant bacterial species and nosocomial infection


concentration dependent drugs and Cmax

enrofloxacin (quinolones), metronidazole, amphotericin, aminoglycosidesgoal Cmax > or = 10 MIC


time dependent drugs and MIC

beta lactams, clindamycin, macrolides, azoles, and vancomycingoal [drug} at or above MIC > or = 50% dosing interval


equation of infection risk

infection risk = contamination x virulence / host resistance


surgical glove punctures occur how often? and how many go unnoticed?

surgical glove perforations occur in 35% after 2 hours of surgery80% go unnoticed