SURGICAL INFECTIONS

INFECTIONS in Surgical Practice
SURGICAL INFECTIONS
In this section, we aim to discuss those infections that present to surgeon because of their PREVLANCE in the population, and may constitute a THREAT to life. 1. STAPHYLACOCCAL INFECTION
1.1 BOILS These are also called furuncles and infections of hair follicles by staphylococci commonly present on the skin.
The infection spreads to tissue around the follicles, and there is a bead of pus formed in the centre.
These are common on the back and can occur in any hair bearing area. Antibiotics may be required if there is cellulitis. Incision may be required. Diabetes should be looked for.
1.2 CARBUNCLE This is the result of neglected boil where the infection has spread to the adjoining hair follicles, dermis and subcutaneous tissue. Usually seen on the back. This is an inflamed indurated mass of skin and subcutaneous tissue with a necrotic surface with visible multiple opening for pus discharge. The patient is usually diabetic.
TREATMENT Antibiotic is administered after sensitivity of the organism is obtained by culture. Incision under General Anaesthesia under antibiotic cover the large central necrotic mass needs to be removed.
1.3 ABSCESS
Any surgical infection that ends in necrosed tissue and collection of pus in the the inflammed area is an abscess. Soft tissue abscess occur in skin (boils, carbuncle), breast, perianal and ischio-rectal regions.
Paronycia (felon) occur in the finger, most of these infections are due to S. Aureus and require antibiotics. All these need to be incised.
Deep rooted abscess i.e in brain, lungs, liver, pancreas can occur by haemotogenic spread
These are a serious complication in surgical infection.
Intraabdominal abscess are a result of disease of bowel leading to a leak and spread of infection to the peritoneum. All these abscesses require identifcation through imaging techniques (ultrasound, Xray and CT) antibiotics and drainage will be required.
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CUTTING COST 2

OT accidents 2 WHAT IS HIV INFECTION?
THE VIRUS
The acquired immune deficiency syndrome (AIDS) was first described in 1981 and the human immunodeficiency virus (HIV) was first identified in 1983. - Antibody tests were developed which revealed the HIV status of the individual. - In 1986 a second strain, HIV 2, was isolated .

- Like hepatitis B, the virus is present in blood and body fluids, but unlike hepatitis B is relatively easily destroyed outside the body, and is not as infectious as the hepatitis B virus.

- Infection of the surgeon can occur from contamination from infected blood or body fluids, either through an open wound, or from a puncture wound like a needle-stick injury.

- Following infection there is an asymptomatic period during which antibody to the virus is not yet present in the blood, and thus HIV tests will be negative. - After approximately 6 months the infected individual may seroconvert, and the HIV antibody be detected.

- A high proportion will then progress to develop AIDS.
LOOK FOR
- A common presenting feature is AIDS sufferers is the Kaposi sarcoma, with an incidence of between 25%and 50%.
Biopsy of such lesions may be the first indicator for the surgeon that the patient has this disease.
- Kaposi sarcomas present as pink to purple blotches like a bruise or blood blister. They may be flat or raised. .
SURGEON’S RISK. Despite the worry of surgeons about risks of infection, these risks are small.
- The prevalence rate of HIV 0.3-7% in our country. Surgeons have been shown to contaminate themselves with blood in 8.7% cases, and sustain penetrating injuries in 1.7% cases The transmission rate is 0.3-0.4%, yet statistically the risk of sero-conversion for a surgeon is one infection every 8 years in a high-risk area with a case-load of 15000 patients per year. As small as one infection every 80 years, in a low risk area. Thus the risk to surgeon at work, is exceptionally low
How ever it wise to; Wear a plastic apron under the gown
Wear eye & face protection mask
Double gloves in all cases of suspected HIV.
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CUTTING COSTS 4

OT ACCIDENTS

WHAT IS HEPATITIS B (SERUM HEPATITIS)?

How does it occur in OT?
This is one of the most infective viruses.
- It may be transmitted from patient to patient by as little as 0.0001 ml. of infected blood
.
- The virus remains active, for up to 6 months in dried blood, consequently instruments which have been poorly cleaned or disinfected, may be responsible for infecting other patients, whilst poor surgical technique, may result in the doctor becoming infected from a patient, thru a needle prick

-It can also be transmitted by entry of patient’s body fluids in the surgeon’s conjunctiva.

- It has been estimated that there are possibly 200 million carriers of hepatitis in the world, representing up to 20% of the population in African, Pacific, and other tropical countries, and 0.5% of the population in Northern Europe.
The current prevalence in the population is from 1-15.8%
- Thus, statistically the doctor or nurse has a 1 in 200 chance of treating a hepatitis B carrier.
- If the doctor becomes accidentally infected with the hepatitis B virus, not only may the disease develop, but the doctor may become a hepatitis B carrier, and is an unacceptable risk to patients and the surgeon may have to give up surgery.
The transmission rate in case of needle stick is 6 to 37%.
To check your risk check the prevalence of hepatitis B in your practice area.
To prevent transmission of virus in suspected cases of Hepatitis B & HIV wear
Plastic Apron under sterile gowns
Plastic eye & face covers
Double gloving

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CUTTING COSTS 3

HOW DO CONFIRM STERILIZATION?
- A chemical monitor is an indicater that is treated with material that changes its characteristics when sterilized.
This may be in the form of special ink that is impregnated into paper strips or tape and placed on the outside of the package, or it may be a substance that is incorporated into a pellet contained in a glass vial.
- The chemical responds to conditions such as extreme heat, pressure, or humidity but does not take into consideration the duration of exposure, which is critical to the sterilization process.
- Another monitoring method used to evaluate the steam sterilizer is the combined temperature time graphs that are installed within the control panel of the sterilizer. These graphs provide a permanent written record of all loads that have been processed.
- The surest way, to determine the sterility of given item, is with the use of biologic controls.
A highly resistant, nonpathogenic, spore-forming bacteria, is used as indicator.
It is contained in a glass vial or a strip of paper.
This is placed in the load of goods, to be sterilized.
-For steam sterilization, the dry spores of the bacteria Bacillus Stearothermophilus are used.
The gas sterilization process uses the bacterium Bacillus Subtilis.
The vial or strip is recovered at the end of the sterilization process and cultured.
This process is time consuming and the results method of testing the efficacy of a sterilization process.
-Biologic controls should be administered at least once weekly.
-If feasible, they should also be used whenever an artificial implant or prosthesis is sterilized and the item withheld from use until the results are known to be negative.
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CUTTING COSTS 2

STERILIZING AND DISINFECTING INSTRUMENTS:
Sterilization is the destruction of all living organisms.
- An item may only be STERIE or NON-STERILE.
- It cannot be NEARLY sterile.
- Disinfection, on the other hand is the REDUCTION of NUMBER of
pathogenic micro-organisms without achieving sterility.
Not all bacterial spores are destroyed in disinfection.

AUTOCLAVES:
This is the most efficient method of sterilizing instruments,
packs and dressings.
This method is suitable for most materials.
An autoclave is basically a pressure cooker a domestic pressure
cooker can be used to sterilize instruments.
The small autoclaves produced for the doctor's surgery have a choice of temperatures, pressures and sterilizing times:
The highest temperature that can be reached by boiling water
at sea level in an open vessel is 100 degree C.
With increased pressure, the water can be raised to much higher temperatures before it boils,e.g.,at a pressure of 0.35kg per cm2 (5p.s.i.) the temperature reaches 105.5 degree C:
At 0.7 kg per cm2(10 p.s.i.). 115 degree C;
At 1.05 kg per cm2 (15 p.s.i.) the temperature will reach 121 degree C, etc.
In a sterilizer chamber(autoclave)which has been exhausted of air,
the steam entering effectively fills, the free spaces surrounding
the load.
As steam contacts, the cool outer layers of the cloth cover, a
film of steam condenses, leaving a minute quantity of moisture in
the fibres of the material.
Air contained in the spaces between the fibers of the material, being heavier than steam, is displaced in a downward direction, and the latent heat given off during the process of condensation is absorbed by that layer of the cloth covering and is sterilized.
The next film of steam immediately fills the space created when
the first film condensed into water, and it does not condense on
the outer layer of the fabrics but penetrates into the second
layer, condenses and heats it.
This process continues until the whole load is heated to its inner depth and no further condensation occurs, the temperature in the core of the pack is that of the surrounding steam.
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