Wound Infection

1
Wound Infection

• Dr. Nisreen Anfanan
• Dr .T.Zamzami

2
Definition of Wound Infection

• Superficial
• Involve skinsc tissue
• Deep( Narcotizing Falsities)

3
Incidence of wound infection
4
Surgical Operation Classification

• Clean lt 2
• Clean-contaminated lt10
• Contaminated 20
• Dirty infected 40
• 
  CDC,1996Cruse,1980

5
Wound Healing

• Inflamation
• vascular
• cellular
• Epithalisation
• Fibroplasia
• Wound contraction

6
Wound infection in gyne ward in KAUH in 2002

• 13 cases ??
• Post cesarean section 8 cases ??
• Post myomectomy 2 cases
• Post lap for ectopic pregnancy 1 case
• Post lap for endometrial cancer 1case
• Post lap for ovarian cancer 1 case

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Risk Factors

• Altered immunocomptence
• Old age
• Obesity
• Prolong preoperative hospitalization
• Excessive blood loss
• Prolong operative time
• Poor nutrition
• Excessive devitalize tissue
• Failure to use prophylactic antibiotic
• Surgery of an infected operative site
• Diabetes mellitus

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Pathogens commonly associated with wound infection
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Prevention

• 1- Preoperative assessment
• Identifytreat all infections remote from the
  surgical site
• Surgical site hair removal (level 1a)
  
• Stop smoking
• Optimize blood glucose (level 1b)

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Prevention

• 2- Theater environmentcare of instrumentation
  Appropriate filters
  Air should
  enter through the ceilingexit near the floor
  Maintain positive pressure
  ventilation of OR
  Maintain mini of 15 air
  changes/hr
  ( category 1B)

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Prevention

• 3)Preoperative and postoperative wound care
  
• Handle tissues gently with good
  homeostasis
• minimized dead space
• contaminated, dirty-infected wound use
  delayed closure(secondary intention)
• 
  level 1b
  

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Prevention

• 4) ANTIBIOTIC PROPHYLAXIS IN SURGERY Choice of
  antibiotic Comprehensive
  risk assessment for choose
• of antibiotic
  Clean
  procedures ( issue of debate) Dirty
  infected (part of treatment)

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ANTIBIOTIC PROPHYLAXIS IN SURGERY

• When ?
• What ?
• How many doses ?

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When?

• Administration of prophylaxis gt 3hr significant
  reduces its effectiveness
• (
  level 1a)
• Ideally within 30 min of induction of aneth
• For CS with clamp of cord

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WHAT TO GIVE ??
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How many doses ?

• During SurgeryAdditional doses during the
  operation
  Insufficient evidence
• (The impact of intra operative bleeding fluid
  replacement on serum drug conc. is negligible)
  
  level2B
• The individual surgeon free to give, extra dose
  for prolong operation, or blood loss
• Total
• 1)one preoperative
• 2)one preoperative and two post operative
• 3)mutilple doses

17
Antibiotic prophylaxis for C/STo give or not to
give (Cochrane Review)

• Randomized trial comparing antibiotic
  prophylaxis or no treatment for both elective
  emergency CS
  
• 81 trials, use of antibiotic reduce the
  incidence of episodes of fever ,endometritis
  ,uti.
• Wound infection reduce with antibiotic
• elective CS RR 0.73 (95 CI 0.53-0.99)
• Em CS RR 0.36( 95 CI 0.26-0.51)
• For all patient RR 0.41(95 CI 0.29-0.43)

18
Single-dose ceftizoxime versus multiple dose
cefoxitin as prophylaxis for vaginal and
abdominal hysterectomy

• Double-blind, controlled
• Efficacy ,safety of single 1g dose of ceftizoxime
  compare with three doses of 2 g cefoxitin
• Prophylactic success rates after vaginal
  hysterectomy 91 for ceftizoxime and 85.1 for
  cefoxitin
• After abdominal hysterectomy success rates 75.3
  for both groups
• J Am Coll surg 1994 feb

19
Single dose versus multiple dose prophylactic
antibiotic

• Randomized trial of one versus three doses of
  Augmentin as wound prophylaxis
• Wound infection with one dose 10.7 compared with
  those give three doses 10.9
• postgrad Med J
  1992

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Treatment of wound infection

• Open the wound
• Evacuate the pus
• Cleansing the wound
• Dressing the wound
• Swab for c/s
• Use antibiotics
• Close the wound

21
Dressing of the wound

• Normal saline
• Hydrogen peroxide
• Non- adherent ,absorbent dressing
• honey

22
Choice of antibiotic

• 1-post operative wound infection without sepsis
  (no GIT,FGT)
• Keflex 500mg po q6 h
• Augmentin 500 mg po q8 h
• Dicloxacillin 500 mg po q6 h
• /-
• Ciprofloxacin 500 mg po q12 h

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Choice of antibiotic

• 2) Post. Op. wound infection with sepsis
  (surgery involving GIT,FGT)
• Cefoxitin 1gm iv q6h or
• Timentin 3.1gm iv q6h
• Cefotaxime 1gm iv q 8 h,
• Ceftriaxone 1-2 gm iv q 24 h
• flagyl iv q8h or imipenum 500 mg iv q6 h
• 
  curr infect rep.2000oct

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Wound closure

• Wound with minimal contamination, controlled
  bleeding, adequate detriments ,no foreign body
  may closed primarily
• Closed wound with minimum tension
• Delayed primary closure can be perform
• after several days of dressing