General Surgery
Mosul university- College of dentistry-oral & maxillofacial surgery departmentDr. Ziad H. Delemi B.D.S, F.I.B.M.S. (M.F.)
Surgical infections ΙΙ
Mosul university- College of dentistry-oral & maxillofacial surgery department
Wound infectionMosul university- College of dentistry-oral & maxillofacial surgery department
Spread of infectionSpread of infection: either by:Self infection or cross infection, self infection either: 1- Locally: Cellulitis 2- Regionally: lymphangitis3- Systemically:–blood stream –bacterimia , septicemia -body cavities – peritonitis , meningitis -lymphatic systemTo other patient
Mosul university- College of dentistry-oral & maxillofacial surgery department
CellulitisCellulitis: it is inflammation of the subcutaneous ( s.c. ) tissue spreading along the s.c. fascial planes & cross the intracellular spaces caused by strep. Pyogens which has entered the tissue through an accidental wound, graze or scratch or following surgical incision. C\P: wide spread swelling, redness, pain without definite localization itching & stiffness of the site central necrosis & suppuration may occur later on. TTT: bed rest, elevation of the part, treat the underlining condition eg: DM, proper AB, if not respond abscess developed & need drainage.
Mosul university- College of dentistry-oral & maxillofacial surgery department
BacterimiaBacterimia: presence of bacteria in the blood as proved by blood culture without indication of toxemia or clinical features. causes: follow dental procedure, o.m., pyelonephritis, major traumatic wound. Complications: multiple metastatic abscess in the distal organs which need treatment.
Mosul university- College of dentistry-oral & maxillofacial surgery department
Septicemia
Septicemia: bacterial proliferation in the blood & their toxins are present in the blood. Routes by which the bacteria reach the blood: Direct through the blood vessels. Release of infected thrombi following thrombosis of blood vessel in the area of inflammation. Discharge of infected lymph node in to the blood following lymphangitis
Mosul university- College of dentistry-oral & maxillofacial surgery department
PyemiaPyemia: circulation of infected emboli composed of mass of M.O. or infected clot lead to multiple focal abscess in many parts of the body. C\P: rigor & intermittent fever with abscess formation such as in the brain, bone, liver. Abscess formation: is a collection of pus, bacteria reach the site of infection by lymphatic, blood stream, local extension.
Mosul university- College of dentistry-oral & maxillofacial surgery department
PusPus: a collection of PMN leucocytes from the proteolytic enzymes causes liquefaction of the tissue. C\P: symptoms: depend on site , size, tension of abscess, & virulence lead to generalized illness, throbbing pain & swelling. sings: (general) ↑ temp. , rigor may occur. (local) 5 signs of inflammation heat, redness, swelling, tenderness, loss of function.TTT: drainage of the pus & culture \sensitivity AB
Mosul university- College of dentistry-oral & maxillofacial surgery department
Mosul university- College of dentistry-oral & maxillofacial surgery departmentDiagnosis of infection
1- C\P 2-laboratory investigation: CBC –leucocytosis blood culture , biopsy in case of granulomatus lesion eg: TB.3- imaging: - conventional X-ray ( fluid level) - radioisotopes study ( Technetium, gallium scan) - U\S: for liver, spleen, kidney, biliary abscess. - C.T scan for brain abscess.
Mosul university- College of dentistry-oral & maxillofacial surgery department
Prevention of infections
1- Antibiotic prophylaxis: when instrumentation or surgery is performed upon a site with normal flora or when infection already exist eg: cystoscopy. AB prophylaxis may be given IV as bolus dose after induction of anesthesia or IM. AB must be given one hour before the surgery eg.: patient with valve heart disease or prosthetic graft of cardiovascular system or with a history of RF & the patient undergo dental surgery or for urethral catheterization give Amoxicillin 3gm orally or Erythromycin 1.5 gm or Clindamycin 600 mg.
Mosul university- College of dentistry-oral & maxillofacial surgery department
2- control of hospital infection: A- preventing of infection at operation ( op. theater cross infection) a- theater design & architecture: the theater best separated from the ward sterilization center also away from the theater Walls smooth easy to wash & use UV light good ventilation to prevent air borne infection chemical antiseptic are used often to clean the op. roomPrevention of infections
Mosul university- College of dentistry-oral & maxillofacial surgery department
b- the surgeon & attendances : no body with overt infection should be allowed into the theater using sterile gowns masks, boots, caps. 3-4 min. washing hands by liquid contain chlorhexidine or iodine spectators should wear caps, mask, gown , little movement as possible, & number as small as possible. patient preop. Shower, & shaving op. area, wear bed clothes. all surgical equipments disinfectedPrevention of infections
Mosul university- College of dentistry-oral & maxillofacial surgery department
B- preventing & control of inf. In the surgical ward: 1-isolation policy. 2- good dressing technique 3- disposable articles 4- urine drainage Foleys catheter should be avoided 5- general cleaning & disinfect the ward: Cotton blanket changed after 2 weeks or when p. discharged sheets changed every 2 days or when p. discharged bed covers changed weekly or when p. discharged walls, floor, furniture, cleaned by chemical antisepticPrevention of infections
Mosul university- College of dentistry-oral & maxillofacial surgery department
Sterilization & disinfectionSterilization: a process of killing all the M.O. & spores including the bacteria , viruses, fungi, parasites , M.O. Disinfection: a process of killing only the vegetative forms of M.O. but leaves the spores intact. It is achieved either by bactericidal or bacteriostatic agents. Antisepsis: a process of prevention of contamination with M.O. to the normal tissue.
Mosul university- College of dentistry-oral & maxillofacial surgery department
1- physical : -heat – dry ( hot air, infrared radiation) -- moist ( pasteurization, boiling, tyndailisation) -- autoclave light ionizing radiation filtration2- chemical : inorganic ( halogens eg. I, Cl…) organic ( alcohol, aldehydes, phenol, cationic surface a.a gaseous agents ( formaldehydes, ethylene oxide) Methods of disinfection