Wound Infections Course Materials

Wound infections Clean, Clean Contaminated and Dirty. Concept Clean wound Definition    Clean contamin ated wound   Contamin ated wound     Dirty Wound   Is non traumatic and lacks inflammation. There is no break in the aseptic technique during the procedure. GIT, resp trat and GU tracts are not entered. Non-traumatic. Has minor breaks in the aseptic technique. GI, rep and GU tracts entered but within minimal spillage of after prior decolonisation. Is a traumatic and exhibits inflammation or gross purulence. There is a major break in aseptic technique during the procedure. GIT, resp or GU tract is entered with gross spillage. Associated with a significant contamination. May involve open, fresh, accidental wound or spillage from GI, resp or GU tracts. Risk of infection postoperatively for Surgical Site Infections.  1% - 5%.  3% -11%.  10 – 17%.  Over 27%. Factors that contribute to infection following a surgical procedure. 1. Germs and contamination:  Germs can enter a surgical wound through various forms of contact. Such as: - Contaminated caregivers. - Surgical instruments - Air.  Exiting germs on or in the body can also spread into the wound during a surgery. 2. Wound classification:  The degree of risk for a surgical site infection is linked to the type of surgical wound: - Clean wound -> 1 – 5 % - Clean contaminated wound -> 3 – 11%. - Contaminated wound -> 10 to 17%. - Dirty wound -> more than 27%. 3. Patient related factors:  Age -> especially over 65.  Overweight or obesity.  Smoking  Diabetes  Immunosuppressive conditions.  Other chronic medical problems or diseases. 4. Surgery related factors:  Duration of surgery  Blood loss  Use of antimicrobial prophylaxis.  Wound management practices.  Post-operative hematomas.  Preoperative skin preparation.  Type of procedure.  Glove changes.  Topical antibacterial preparations. Diagnostic Features and Treatment for Common Wound Infections. Visual Observations      Before doing any diagnostic tools, most doctors will suspect a wound infection via visual inspections. Typical signs of a wound acute wound infection include: - Pain - Erythema - Warmness - Purulent exudate.  These may be modified in chronic wounds by underlying comorbidities. Additional signs include: - Delayed healing - Discolouration - Friable granulation tissue - Serous exudate - Epithelial bridging/pocketing in granulation tissue. - Foul Odor. - Wound breakdown.  Signs such as changes in exudate, granulation tissue, discolouration of wound bed and wound brigading can be associated with colonisation rather than infection. Acute wound infection has apparent signs and symptoms since it is generally cause by a single organism while, while chronic wound infections has less obvious signs due to multiple pathogens. The visual inspection DOES NOT provide any definite determination. Signs and symptoms at different stages of the wound infection continuum. Contaminat ion    Colonisatio n Local Infection    Spreading Infections   Systemic Infections     All open wounds may have microorganisms. They will not multiple or persistent until a suitable nutritive and physical conditions are available for each microbial species. Thus, their presence is only transient and wound healing is not delayed. Microbial species successfully grow and divide, but do not damage the host or initiate wound infection. Covert subtle signs of local infection: - Hyper granulation - Excessive vascular tissue - Bleeding - Friable granulation - Wound breakdown - Enlargement - Delayed wound healing beyond expectations. - New or increasing pain - Increasing malodour. Overt classical signs of local infection: - Erythema - Local warmth - Swelling - Purulent discharge - Delayed wound healing beyond expectation - New or increasing pain - Increasing malodour. Extending in duration +/- erythema, lymphangitis, crepitus, wound breakdown/dehiscence with or without satellite lesions, malaise/lethargy or non-specific general deterioration, loss of appetite, inflammation, swelling of lymph glands. Severe sepsis Septic shock Organ failure Death