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Perioperative Infection Control Flashcards

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1
Q

what is a surgical site infection a type of?

A

hospital acquired infection

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2
Q

what is classed as a hospital acquired infection?

A

any infection which occurs from when a patient goes into hospital up to 30 days post discharge

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3
Q

what is one of the most common nosocomial infections?

A

SSI

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4
Q

what are the 3 broad factors that can contribute to SSI?

A

patient
surgery
environment

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5
Q

what can the development of SSI lead to?

A

poor healing
delayed healing time
increased medical costs
possible revision surgery
detrimental effect on client relationships
reduced patient welfare
increased antibiotic use

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6
Q

what is important when discussing surgery with owners?

A

highlight risk of SSI in any surgery

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7
Q

what is the main issue with increased antibiotic use?

A

risk of resistant infection
antibiotic stewardship

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8
Q

what are the steps to take when a SSI is suspected?

A

identify infection location
assess the extent of the infection
culture for targeted antibiotics
good wound management
good infection control techniques

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9
Q

what should be assessed about the extent of an SSI?

A

size
is it just around the wound
is it deeper and involved with implants

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10
Q

what is involved in good wound management?

A

aseptic handling
keep clean
apply dressings as needed

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11
Q

what is required for SSI to form?

A

introduction of microorganisms into the surgical wound

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12
Q

what are the sources of SSI?

A

exogenous
endogenous

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13
Q

where do exogenous sources of SSI originate from?

A

source outside of the patient (e.g. surgeon, equipment or environment)

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14
Q

where do endogenous sources of SSI originate from?

A

the patient themselves (e.g. patient flora)

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15
Q

what source do most SSIs originate from?

A

endogenous

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16
Q

what areas of preop management require compliance in order to reduce SSI?

A

antimicrobial prophylaxis
pre-op bathing
hair removal
aseptic prep
care of prepped surgical site
hand hygiene

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17
Q

what is the most crucial factor in preventing SSI?

A

hand hygiene

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18
Q

what can be done to prevent endogenous sources of SSI?

A

thorough clipping
no clipper rash
large margins
removal of hair from trolley
correct skin prep with right solution and contact time

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19
Q

what are the factors which predispose SSI?

A

patient
environment
treatment

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20
Q

what can be done to prevent exogenous sources of SSI?

A

good surgeon compliance with prep
equipment sterilisation
environment well cleaned and managed

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21
Q

what are the main patient factors which may influence SSI?

A

body condition or age
immunosuppression
endocrinopathies
remote infection
skin disease
recent operation
prior site radiation
perioperative temperature

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22
Q

how may body condition affect risk of SSI?

A

malnutrition could lead to lowered albumin and so poorer immune response

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23
Q

how may age affect risk of SSI?

A

less able to fight infection
over 10 - poor immune response
under 1 year - underdeveloped immune system

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24
Q

how may immunosuppression or endocrinopathies affect risk of SSI?

A

reduced ability to fight infection
may be on medical therapy like steroids which affects immunity

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25
how may remote infection affect risk of SSI?
seeding of infection bacteria already in blood stream
26
how can you be aware of remote infection before surgery?
may not always be aware look for other wounds / areas of infection
27
how may skin disease affect risk of SSI?
bacteria from skin surface can enter wound
28
how may skin disease affect surgery?
elective procedures may be postponed until skin has healed
29
how may recent operation affect risk of SSI?
suture material is FB tissue adhesions
30
how may perioperative temperature affect risk of SSI?
vasoconstriction is hypothermic may affect blood flow to wound and limit WBC
31
what are the main environment factors which may influence SSI?
patient prep cross contamination aseptic technique theatre conduct cleaning methods inadequate ventilation
32
how can patient prep be performed to reduce SSI risk?
separate area for prep correct products used for prep with correct contact time avoid pre clipping clip well and throughly (no rash or left hair)
33
how can cross contamination be prevented to reduce SSI risk?
good handwashing
34
what aspects of theatre conduct can reduce SSI risk?
minimal personnel correct attire worn at all times
35
how can theatre cleaning be performed to reduce SSI risk?
correct / most appropriate disinfectants used damp dusting performed regular deep cleaning deep cleaning following dirty surgeries/infectious cases dirty surgeries at end of day
36
how can ventilation reduce SSI risk?
higher temperatures provide better environment for bacteria to grow slightly cooler and good air flow can prevent
37
what types of ventilation are available?
ultraclean linear flow air conditioning
38
what are the main treatment factors which may influence SSI?
surgical time experience inadequate antibiotic prophylaxis drains emergency procedure surgical implants suture material selection
39
how does surgical time affect risk of SSI?
infection rate thought to double with every hour of surgical time
40
how does experience affect risk of SSI?
halsteads principles inexperienced surgeons may take longer
41
what are Halsteads principles?
handle tissues gently control haemorrhage carefully preserve blood supply strict asepsis minimise tissue tension appose tissues correctly remove dead space
42
why are drains an SSI risk?
entry into body for bacteria to track up
43
how do emergency patients affect risk of SSI?
patient may not be ideal surgical candidate and may have SSI risks but will need surgery to prevent death
44
how do surgical implants affect risk of SSI?
foreign body
45
how does suture material selection affect risk of SSI?
correct choice for tissue being sutured
46
what is the most important aspect of infection control?
hand hygiene
47
what are the 5 moments for hand hygiene?
before and after touching a patient before and after touching patient environment before aseptic procedure skin contamination with body fluids before gloving
48
what handwashing technique should be followed?
WHO handwash
49
describe WHO handwash
palm to palm right palm over left dorsum with fingers interlocked and vice versa palm to palm with fingers interlocked backs of fingers to opposing palms with fingers interlocked rotational rubbing of left thumb in right palm and vice versa rotational rubbing of finger tips in opposing palm and vice versa
50
how does surgical classification influence SSI?
relationship between classification and SSI (more dirty = more SSI)
51
what are the surgical classification categories of wounds/procedures?
clean clean-contaminated contaminated dirty
52
what are clean wounds / procedures?
non-traumatic surgical wounds that do not involve the opening of the respiratory, GI, genitourinary or oropharyngeal tracts
53
what are examples of clean surgical wounds/procedures?
TPLO total hip
54
what are clean - contaminated wounds / procedures?
surgical wounds with aseptic prep that involve entering the respiratory, GI, genitourinary or oropharyngeal tracts in controlled conditions or placing a drain
55
what are contaminated wounds / procedures?
open wounds spillage of GI contents/infected urine break in aseptic technique
56
what are dirty wounds / procedures?
old purulent wounds, foreign bodies, faecal contamination
57
what are examples of dirty wounds?
RTA dog bite stick injury
58
what are examples of contaminated wounds/procedures?
leakage of GI contents into abdomen
59
what is the published infection rate for clean surgeries?
0.4-4%
60
what are the clean wounds most likely to result in infection?
duration over 90 mins implant use inexperienced surgeon
61
what is the published infection rate for clean - contaminated surgeries?
4.5-9.3%
62
what is indicated for clean - contaminated surgeries?
antimicrobial prophylaxis culture / targeted use
63
what is the published infection rate for contaminated surgeries?
5.8-28.6%
64
what can help reduce degree of infection in contaminated wounds?
good management
65
what is involved in management of contaminated wounds?
lavage debridement antibiotic therapy with swab for culture
66
when should antibiotics be used?
Implants where infection would be catastrophic Surgery over 90 minutes Clean/ contaminated, contaminated, dirty procedures
67
what is involved in the selection of antibiotics for surgical use?
VS decision Most likely bacterial contaminant (Staphylococcus, e.coli) Culture results
68
what is the most effective time for prophylactic antibiotic administration?
30mins - 1 hour prior to surgery (IV)
69
how frequently should prophylactic antibiotic administration occur during surgery?
every 90 mins
70
when should prophylactic antibiotic administration stop following surgery?
within 24 hours of clean surgery
71
how long should sterile dressings be on a wound post op?
24-48 hours
72
should dressings be reapplied if soiled?
if within 24-48 hours post op then yes but no evidence to support continued dressing use after this time
73
what is the risk with repeated dressing changes?
contamination and infection
74
what is involved in post operative care to prevent infection?
apply sterile dressing for initial 24- 48 hour period Remove drains as soon as possible Strict hygiene Nutrition and monitor
75
what is drain removal based on?
reduced production VS decision
76
what is involved in strict post op hygiene?
kennel cleaning handwashing
77
why is nutrition in the post op period crucial?
bosst immune system management of nausea crucial
78
what are patients to be monitored for in the post op period?
pain temperature obs wound itself for signs of infection
79
how may patients with implants be managed?
aseptic handling of wound restriction of exercise
80
what should the wound be observed for?
exudate increase or change heat swelling pain
81
what should the owner be made aware of on patient discharge?
signs of wound infection
82

Advanced Clinical Nursing Theory (36 decks)

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