Hospital Infections Flashcards
(36 cards)
What type of infections are most common in post-op patients?
Respiratory
UTIs
Bacteraemias (cannula associated, MRSA)
Abx related diarrhoea
How are most surgical site infections caused?
Contamination of incision w/pt own microorganisms during surgery
How can surgical infections be minimised pre-op?
- Hair removal: Use electric clippers NOT razors (↑ risk)
- Prophylactic antibiotics
- Remove all jewellery
How can surgical infections be minimised intra-op?
- Prep the site of incision immediately before op using antiseptic (Chlorhexidine/ Povidone‑iodine)
- Cover w/appropriate dressing when done
- use iodophor-impregnated drape
How can surgical infections be minimised post-op?
- Refer to tissue viability nurse for wounds healing by 2° intention
- Antibiotic Tx post-op for dirty/infected surgery
- Use sterile saline for wound cleaning <48 hours post-op
- > 48hours can use tap water for cleaning
When can patients shower post-op?
> 48hours
What is post-op fever?
Temp >38°C on 2 consecutive days post-op
OR
Temp >39°C on any 1 post-op day
What are the causes of Post-op fever at 0-48hours?
- Pyretic response to surgery- MOST COMMON
- TSS from Staph Aureus/group A beta-haemolytic Strep infection
- Drug induced: Heparin, Allopurnol, Ig, Salicylates, PhenyT, Furosemide, Thiazdies, Abx
- Malignant hyperthermia
- Transfusion reactions
- Traumatic surgery
- Transplant rejection
How is post-op fever treated?
Conservative: Self-limiting, resolves in 2-4days
Antipyrexial: Paracetamol
Tx underlying cause
What are the causes of Post-op fever at >48hours-7days?
90% infectious cause
-Infection from surgery: Wound cellulitis
-Infection from invasive access: UTI, Pneumonia, Cannula-related thrombophlebitis, catheter related infections
-Infection from blood products: RARE, Yersinia, Pseudomonas, Staph, Salmonella , enterococci, Clostridium
CONSIDER: OH- withdrawal
What infectious cause is likely to cause pyrexia post-op in the first 1-3days?
Group A Strep
Clostridium
When are fat emboli post-op most likely to present?
48-72hours
What are the causes of Post-op fever at >7-28days?
INFECTION:
- UTI
- Pneumonia
- C.Diff
- Wound cellulitis
- Foreign-body reaction
- OSTEOMYELITIS (complication of orthopaedic surgery seen 2w post-op)
- DVT/PE
What are the causes of Post-op fever at 4weeks?
- Osteomyelitis (implant infection)
- Infective endocarditis
What are the signs of malignant hyperthermia? How is it treated?
Tachycardia Metabolic acidosis ↑↑temperature Muscle rigidity Tx = Dantrolene
How does TSS present?
Fever Hypotension Skin Sx: Diffuse macular erythroderma Shock Multi-organ failure
How is Post-op fever investigated?
Fever <48hours DOES NOT need investigating
?TSS = Blood Cultures
>48hrs:
Bloods: FBC, Urine MC&S, CXR, blood & wound cultures
What antibiotics is MRSA resistant to?
Beta-lactams (penicillins)
Cephalosporins
In what type of infections if MRSA commonly found?
Bacteraemias Pneumonia Endocarditis Joint infection Skin/soft tissue infection- MOST COMMON
What are the signs that an infection may be due to MRSA?
Not responsive to penicillins
Abscess formation
Fever
Fatigue
What are the risk factors for MRSA infection?
Nasal colonisation >50yo IVDU Indwelling device Current wound Prev MRSA Exposure to MRSA +ve pt HIV infection
How is an infection caused by MRSA investigated?
Bloods: FBC
Blood, urine, tissue, sputum cultures
PCR
How is ongoing MRSA managed?
Topical Chlorhexidine 2-4% used as wash in single application
Topical Mupirocin 2% applied to nares BD for 5-7days
How is an acute infection by MRSA managed?
Debridement of wound
Oral/IV antibiotics: Tetracycline + Clindamycin
or Vancomycin + glycopeptides
