SURGICAL SITE INFECTION
Clinical scenario involving a 24-year-old male post-appendicectomy presenting with abdominal pain and concerns of wound infection. The tutorial discusses surgical wound infections, risk factors, prevention strategies, and principles of management, providing insights for approaching such cases as a surgical FY1.
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Presentation Transcript
SURGICAL SITE INFECTION CLINICAL TUTORIAL Keir Mailley Core Surgical Trainee
Clinical Scenario Surgery Ward You are a surgical FY1 M. DeBakey Asked to review patient by nursing staff 24M They are concerned his wound looks infected? Abdo pain
Information o Otherwise well 24 year old man o Presented with a short history of abdominal pain,umbilicus migrating to RIF o Underwent open appendicectomy3 days ago, remained on the ward due to pain o Observations - HR 102 BP 122/83 RR 13 Sats 98% (A) Temperature 38.2 oC o Laboratory tests of note - WCC 12 - CRP 105 - Otherwise unremarkable o Operation note - Open appendicectomy, antibiotics given at induction of anaesthesia, inflamed appendix, no evidence of perforation and contamination
What is a surgical wound infection? o Healthcare associated infection after invasive (surgical) procedure o Spectrum of disease - Self limiting - Localised abscess/collection that spontaneously discharges - Localised abscess/collection that requires intervention - Life threatening infection
Risk factors Diabetes Smoking Steroid use Immunosuppression Co-morbidity
How do we prevent them? oPre-operatively - Hair removal - Antibiotic prophylaxis oIntraoperative - Surgical scrub - Sterile gowns - Sterile field - Antiseptic skin preparation oPost operative - Use an aseptic non-touch technique for changing orremoving surgical wound dressings
Principles of management oMark area oWound swab and culture oInflammatory markers oIf pyrexial, blood cultures oSenior input oPO/IV abx depending on patient condition (abx as per local guidelines) oIf complex, tissue viability input can be of benefit
Many thanks! Any Questions?
