co-existing 26 & 27 Flashcards by lindsey france

risk factors for surgical site infection

patient related factors

extremes of age
poor nutritional status
asa > 2
diabetes mellitus
smoking
obesity
co-existing infections
colonization
immunocompromised
longer preoperative hospital stay

How well did you know this?

Not at all

Perfectly

risk factors for surgical site infection

microbial factors

enzyme production
polysaccharide capsule
ability to bind to fibronectin
biofil and slime formation

How well did you know this?

Not at all

Perfectly

risk factors for surgical site infection

wound related factors

devitalized tissue
dead space
hematoma
contaminated surgery
presence of foreign material

How well did you know this?

Not at all

Perfectly

SSI rate for extrabdominal surgery

2-5%

How well did you know this?

Not at all

Perfectly

SSI rate for intrabdominal srugery

20%

How well did you know this?

Not at all

Perfectly

out of nosocomial infections what percent is SSI

rendering patients % more likely to spend time in ICU

5 times more likely to…

twice as likely to die

14-16%

60% ICU time

How well did you know this?

Not at all

Perfectly

what “bug” is the predominant cause of SSI

MRSA

How well did you know this?

Not at all

Perfectly

how many days within surgery do SSI present

30 days

How well did you know this?

Not at all

Perfectly

significant alcohol consumption preop results in

immunocompromise

How well did you know this?

Not at all

Perfectly

muprocin to nares

successful in eliminating carrier state of S Aureus

concern may promote resistance

How well did you know this?

Not at all

Perfectly

hair clip or shave

Hair clip- shaving increases risk of SSI- due to micro cuts

How well did you know this?

Not at all

Perfectly

preop skin cleanse with

chlorhexidine

How well did you know this?

Not at all

Perfectly

timing of abx

1 hours prior to incision

if surgery greater than 4 hours- may necessitate a second dose

How well did you know this?

Not at all

Perfectly

discontinue propholaxysis within

24 hours

48 hours cardiac

How well did you know this?

Not at all

Perfectly

surgical infection prevention guidelines

1-7

abs within 1 hours of surgical incision
stop at 24 hours or 48 hours- cardiac
increase dose of abs for larger patients
repeat dose when surgery exceeds 4 hours
administer appropriate for local resistance patterns
follow aha guidelines for patients at risk for infective endocarditis
adhere to procedure specific antibiotic recommendations

How well did you know this?

Not at all

Perfectly

Superficial incisional SSI

within 30 days of surgery

superficial pus drainage
organisms cultured from superficial tissue or fluid
signs and symptoms -pain, redness, swelling, heat

How well did you know this?

Not at all

Perfectly

deep incisional SSI

within 30 days of surgery or 1 year if prosthetic implant present

deep pus drainage
dehiscence or wound opened by surgeon (temp greater 38, pain tenderness)
abscess (radiographically diagnosed)

How well did you know this?

Not at all

Perfectly

organ/space SSI

within 30 days of surgery or within 1 year of prosthetic implant present

pus from drain in the organ/space
organisms cultured from ascetically obtained specimens or fluid or tissue in the organ/space
abscess involving the organ/space

How well did you know this?

Not at all

Perfectly

what does hypothermia do to the incidence of SSI

increase the incidence of SSI

How well did you know this?

Not at all

Perfectly

oxygen tension and SSI incidence

up to 80% decreases SSI(controversial)

How well did you know this?

Not at all

Perfectly

analgesia and and SSI incidence

superior treatment of surgical pain is associated with decrease incidence of SSI

How well did you know this?

Not at all

Perfectly

It is considered a BSI Signs and symptoms develop within how many hours

48hrs

How well did you know this?

Not at all

Perfectly

common pathogens associated with blood stream infection

gram positive bacteria (59%)

coagulase-negative staphylococci
staphlyoccus aureus
enterococci
streptococus pneumoniae

How well did you know this?

Not at all

Perfectly

common pathogens associated with BSI

gram negative bacteria (31)%

How well did you know this?

Not at all

Perfectly

systemic inflammatory response syndrome (SIRS)

diagnosis must have two or more ``` WBC greater 12,000 10%bands heart rate great 90 temp greater than 38 or less than 36 respiratory rate greater than 20 or paco2 less than 32 ```

sepsis goals

``` map 65 cvp 8-12 adequate urine output with out lactic acidosis mixed svo2 above 70% ```

antibiotic therapy most commonly associated with C difficile infection

``` clindamycin fluoroquinolones cephalosporins, carbapenems, monobactams macrolides sulfonamides pCN tetracyclines ```

largest transmission category of HIV

men who have sex with men 63%

second largest transmission category of HIV

heterosexual sex twice as many women as men get infected 25%

what percent of HIV patients have abnormal echo

50%

pericardial effusion is present in

25%

what asa status do HIV /AIDS patient get without any clinical evidence of deterioration

asa 2

depending on severity of diseases and coexisting disease what asa might hiv/aids gets

asa3-4

does having hiv/aids increase post surgical complicaitons

what is commonly seen during anesthesia with HIV patitns

tachycardia.

what is commonly seen postop

fever anemia and tachycardia are more frequent

HIV positive parturient can they get epidurals

yes and blood patches

innate immunity

passed on through the generations-

acquired immunity (adaptive immunity)

more mature system - delayed onset of action.

immune dysfunction - tell me the three types

inadequate immune response excessive immune response misdirected immune response

who has more neutrophils who has less

new borns have a higher granulocyte count african americans have a lower granulocyte count

kostmann syndrome

inhibits neutrophil maturation

name drugs associated with neutropenia

chloramphenicol, antithyroid meds, analgesia, TCA's *any drug can produce severe life threatening neutropenia*

alcoholics have decreased neutropenia

ethanol toxic effects on marrow precursor cell compromise.

two most common causes of antineutrophil antibodies

SLE & RA

leukocyte adhesion deficiency

higher risk of recurrent bacterial infections

chediak-higashi syndrome

albinism, frequent bacterial infections, mild bleeding diathesis, progressive neuropathy, cranial nerve defects- WBC destroyed before leaving the bone marrow

neutrophil-specific granule deficiency syndrome

impaired chemotaxis and bactericidal activity | frequent bacterial and fungi infections

G-CSF

granulocyte stimulating factor beneficial for HIV patients- beneficial for neutropenic patients under going elective surgery

what activates the complement system

patogen dependent (classical) pathogen -independent (alternative)

how does the complement system work

it coats the bacterial in protein to facilitate phagocytosis.

what is the primary organ for complement synthesis

liver

deficiency of C1 esterase inhibitor is responsible for

hereditary angioedema

patients receiving prednisone, stress, exposure to certain drugs and smoking have what?

granylocytosis

what is not useful in the treatment of acute angioedema

androgens catecholamines antihistamines and antkbibrinolytsi are not useful

iga deficiency

recurrent sinus and pulmonary infections will experience anaphylaxis if exposed to iga

cold autoimmune diseases

igm and iga antibodies agglutinate in response to temp less than 33

macroglossia featured during amyloidosis

large tongue- cardiac dysfunction

DIGEORGE syndrome

diminished or absent thymus gland

latex response vs drug response

30 mintes drugs 5-10min

does cross senesitivity exist between muscle relaxants

yes

abs cross sensitivity

very low

most common drugs for allergy

muscle relaxants antibiotics- b lactam drugs, sulfonamides, vancomycin, quinolone latex