Wound classification, infection and antimicrobial use Flashcards Preview

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Flashcards in Wound classification, infection and antimicrobial use Deck (40)
1

Surgical wound are classified by degree of what?

Contamination

2

What does classification of surgical wounds predict?

Likelihood of infection

3

What number of organisms must be present in order to diagnose a bacterial infection?

> 100,000 organisms/gram of tissue

4

What are the 4 classifications of surgical wounds?

  1. Clean
  2. Clean contaminated
  3. Contaminated
  4. Dirty 

5

T/F: A clean wound is a non-traumatic, non-infected operative wound

TRUE

6

In order to be classified as a clean wound, which tracts must NOT be entered? Examples?

Oropharyngeal, GIT, urinary, and respiratory tracts not entered

Ex: exploratory, neuter

7

What is a clean contaminated wound? What are some examples?

Clean wound in which tract is penetrated

No gross contamination

Ex: gastrotomy, hole in glove detected

8

Which wound classification does this describe:

Traumatic wound

No purulent discharge

Spillage of GIT contents or urine

Major aseptic break

Contaminated

9

What are two examples of a contaminated sx wound?

Bile spillage

Touched mask

10

Can a contaminated wound be converted to a clean contaminated wound?

Yes--early debridement and lavage can convert them

11

What classifies as dirty wounds?

  • Infected wounds
  • Wounds with pus
  • Perforated hollow viscus
  • > 100,000 organisms/gram of tissue

12

A ruptured stomach and cat fight abscess classify as which type of wound?

Dirty

13

T/F: All surgical wounds are contaminated by bacteria

TRUE

14

What is the incidence of infection for surgical wounds?

5%

15

What is the goal of aseptic technique?

Minimize the incidence of surgical wound infection

16

What are the degrees of bacterial contamination for each wound classification (percentages)?

  • Clean = 0-4.8%
  • Clean contaminated = 3.5-5%
  • Contaminated = 4.6-12%
  • Dirty = implies infection

17

How does clipping at the surgical site increase risk of contamination? How can you minimize that risk?

Leaves nicks in skin-->allows bacteria to colonize

Only clip immediately pre-operatively

18

T/F: normal wound healing enhances the immune system

FALSE--it suppresses the immune system

19

How can longer surgeries increase risk of infection?

  • Tissue trauma
  • Suture/hemostasis
  • Environmental exposure

20

T/F: For duration of both surgery and anesthesia, risk of infection doubles every hour

TRUE

21

Can prolonged exposure to anesthetic drugs suppress immunity?

YES

22

T/F: Anesthetic drugs don't have any chances of becoming contaminated

FALSE--some drugs are eaily contaminated

Ex: propofol can support microbial growth

23

What 3 endocrinopathies are risk factors for infection?

Diabetes mellitus

Hyperadrenocorticism

Hypothyroidism

24

Which sex has a higher risk factor for infection? Why?

Intact male cats and dogs

Androgens effect on the immune system

25

T/F: The higher number of people in the OR, the higher the chance of infection in the patient

TRUE

26

T/F: Supplemental oxygen may increase the risk of surgical wound infection

FALSE

27

What is the difference between prophylactic and therapeutic antibiotics?

  • Prophylactic
    • Use of an antibiotic to protect a patient from an anticipated bacterial invasion
      • Administered prior to wound contamination
  • Therapeutic
    • Infection already exists and needs to be treated

28

When should prophylactic antibiotics be used?

Examples?

  • If risk of infection is relatively high
    • Many clean contaminated procedure
    • Contaminated procedures
    • Patient factors (pre-existing prosthesis)
    • Type and length of sx (>90 min)
    • Surgeon experience
  • When an infection would be disastrous
    • Ex: total hip replacement

29

Which is preferred when selecting antibiotics: -static or -cidal?

-cidal

30

What bac. and antibiotic choice occurs in clean procedures?

Staphylococcus

Cephazolin

31

What bac. and antibiotic choice occurs in clean contaminated procedures of the upper GIT?

Enterococci

Cephazolin

32

What bac. and antibiotic choice occurs in clean contaminated wounds of the cecum and colon?

Anaerobes

Cefotoxin 2nd generation

33

What is the goal of correct timing of prophylactic antibiotics?

To achieve highest concentrations at start of and duration of surgery

34

When should prophylactic antibiotics be administered?

1 hour prior

Repeat every 2 hours during surgery

35

When should prophylactic antibiotics NOT be delivered? Why? Is there an exception?

  • Do not administer beyond 24 hrs post surgery
    • Alters organism susceptibility
    • Increases infection rates
  • Unless gross contamination
    • Prophylactic becomes therapeutic 

36

When are preventative antibiotics used in surgery?

  • Intraoperative use when unexpected contamination occurs
    • Spillage of intestinal contents
  • Surgery longer than expected (>90 min)

37

T/F: Intraoperative prevetative antibiotic use has been proven to be beneficial

FALSE

38

What are the indications for therapeutic antibiotics?

Systemic infection

Surgical site infection

Any contaminated or dirty procedure

39

What should therapeutic antibiotic choice be based on? When should it be given?

Based on C/S

Start prior to surgery and continue >2-3 days post surgery

40

How can you minimize post-operative infections?

Use glove and wash hands

Protect/clean incisions

Drains and catheters