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Wound
Factors determining diversity of
microbes in wound ( often polymicrobial )
Wound type,
depth,
location,
level of tissue perfusion ( O2#, nutrients, immune
cells ),
host immune response.
the presence of foreign material and devitalized
( ischaemic, hypoxic or necrotic ) tissue
#A significant reduction in the killing capacity of PMNs at a pO2 of <30 mm Hg has been
reported
Wound infection
Occurs when virulence factors expressed by
microbes in wound outcompete the host
immune system and subsequent invasion and
dissemination of microorganisms in viable
tissue provokes a series of local and systemic
host responses.
Characteristic local responses are :
- purulent discharge,
- painful spreading erythema ( cellulitis )
Risk of surgical wound infections
Based on the susceptibility of a surgical wound
to microbial contamination.
Clean surgery : 1 to 5% risk .
Dirty procedures ( e.g organ space
involvement) are significantly more
susceptible to endogenous contamination:
27% risk.
Both acute and chronic wounds are
susceptible to contamination and colonization
by a wide variety of aerobic and anaerobic
microorganisms.
Sources of wound contamination
Surrounding skin ( normal flora such as CONS,
micrococci, diphtheroids, and
propionibacteria), and
Environment ( in the air or introduced by
traumatic injury )
Endogenous sources involving mucous
membranes (primarily the GIT, oropharyngeal,
and genitourinary mucosae)
Minimizing post op wound
infection
1. Adequate asepsis
2. Adequate antisepsis
3. Preservation of the local host defenses .
Asepsis
Utilization of effective infection control
procedures (e.g., air filtration, skin barrier
garments, disinfection) to minimize exogenous
microbial contamination during surgery.
Antisepsis
Antiseptics on the operative site ,
Antibiotic prophylaxis at a time point just prior to
surgery that will ensure adequate tissue levels of
antibiotic during surgery.
Ensuring good aseptic, skilled surgical techniques
and minimizing the duration of surgery.
Prolonging ab prophylaxis is NOT a substitute to
good surgical technique!!!
Optimizing the local wound conditions.