Wound Infection

Dr. Nisreen Anfanan

Dr .T.Zamzami
 Definition of Wound Infection

• Superficial
Involve skin&sc tissue

• Deep( Narcotizing Falsities)

Incidence of wound infection
Site Incidence

International 5-34 %

USA 14-16 %

KKUH for CS 4.5 %

KAUH ??
Surgical Operation Classification

• Clean <2 %

• Clean-contaminated <10 %

• Contaminated 20 %

• Dirty infected 40 %

CDC,1996:Cruse,1980
 Wound Healing
*Inflamation
vascular
cellular
*Epithalisation
*Fibroplasia
*Wound contraction
 Wound infection in gyne ward in
KAUH in 2002
• 13 cases ??
• Post cesarean section 8 cases ??
• Post myomectomy 2 cases
• Post lap for ectopic pregnancy 1 case
• Post lap for endometrial cancer 1case
• Post lap for ovarian cancer 1 case
Risk Factors
Altered immunocomptence
Old age
Obesity
Prolong preoperative hospitalization
Excessive blood loss
Prolong operative time
Poor nutrition
Excessive devitalize tissue
Failure to use prophylactic antibiotic
Surgery of an infected operative site
Diabetes mellitus
 Pathogens commonly associated
with wound infection
PATHOGEN FREQUENCY %
Staphylococcus aureus 20
Coagulase-neg stphylococci 14
Enterococci 12
E-coli 8
Pseudomonas aeruginosa 8
Enterobacter species 7
Klebsiella pneumonia 3
Bacteriod fragilis 2
 Prevention
1- Preoperative assessment
• Identify&treat all infections remote from
the surgical site
• Surgical site hair removal (level 1a)
• Stop smoking
• Optimize blood glucose (level 1b)
 Prevention
• 2- Theater environment&care of
instrumentation
Appropriate filters
Air should enter through the ceiling&exit
near the floor Maintain positive
pressure ventilation of OR
Maintain mini of 15 air
changes/hr
( category 1B)
 Prevention
3)Preoperative and postoperative wound care
*Handle tissues gently with good
homeostasis
*minimized dead space
* contaminated, dirty-infected wound use
delayed closure(secondary intention)
level 1b
 Prevention

4) ANTIBIOTIC PROPHYLAXIS IN SURGERY

*Choice of antibiotic
*Comprehensive risk assessment for choose
of antibiotic
*Clean procedures ( issue of
debate) *Dirty –infected (part of
treatment)
 ANTIBIOTIC PROPHYLAXIS IN
SURGERY
• When ?

• What ?

• How many doses ?

 When?
• Administration of prophylaxis > 3hr
significant reduces its effectiveness
( level 1a)
• Ideally within 30 min of induction of aneth

• For CS with clamp of cord

 WHAT TO GIVE ??
Procedure antibiotic dosage
Vaginal or Cefazolin 2 g iv single
Abdominal dose
hysterectomy Mertronidazol 500 mg iv single
dos
laparoscopy None

Cesarean section Cefazolin 1g iv single

dose
 How many doses ?
*During Surgery:Additional doses during the operation
Insufficient evidence
(The impact of intra operative bleeding &fluid replacement
on serum drug conc. is negligible)
level2B
The individual surgeon free to give, extra dose for prolong
operation, or blood loss
Total:
1)one preoperative
2)one preoperative and two post operative
3)mutilple doses
 Antibiotic prophylaxis for C/S
To give or not to give
(Cochrane Review)
• Randomized trial comparing antibiotic
prophylaxis or no treatment for both elective&
emergency CS

• 81 trials, use of antibiotic reduce the incidence of

episodes of fever ,endometritis ,uti.
*Wound infection reduce with antibiotic:
• elective CS RR 0.73 (95% CI 0.53-0.99)
• Em CS RR 0.36( 95% CI 0.26-0.51)
• For all patient RR 0.41(95% CI 0.29-0.43)
 Single-dose ceftizoxime versus multiple dose cefoxitin as
prophylaxis for vaginal and abdominal hysterectomy

• Double-blind, controlled
• Efficacy ,safety of single 1g dose of ceftizoxime
compare with three doses of 2 g cefoxitin
• Prophylactic success rates after vaginal
hysterectomy 91% for ceftizoxime and 85.1% for
cefoxitin
• After abdominal hysterectomy success rates
75.3% for both groups
J Am Coll surg 1994 feb
 Single dose versus multiple –
dose prophylactic antibiotic
Randomized trial of one versus three doses of Augmentin as
wound prophylaxis

Wound infection with one dose 10.7% compared with those

give three doses 10.9%

postgrad Med J 1992

Treatment of wound infection
• Open the wound
• Evacuate the pus
• Cleansing the wound
• Dressing the wound
• Swab for c/s
• Use antibiotics
• Close the wound
 Dressing of the wound
• Normal saline

• Hydrogen peroxide

• Non- adherent ,absorbent dressing

• honey
 Choice of antibiotic
1-post operative wound infection without sepsis (no
GIT,FGT)
*Keflex 500mg po q6 h

*Augmentin 500 mg po q8 h

*Dicloxacillin 500 mg po q6 h
+/-
*Ciprofloxacin 500 mg po q12 h
 Choice of antibiotic
• 2) Post. Op. wound infection with sepsis (surgery
involving GIT,FGT)
*Cefoxitin 1gm iv q6h or
*Timentin 3.1gm iv q6h
*Cefotaxime 1gm iv q 8 h,
*Ceftriaxone 1-2 gm iv q 24 h
+
*flagyl iv q8h or imipenum 500 mg iv q6 h

curr infect rep.2000oct

Wound closure
• Wound with minimal contamination,
controlled bleeding, adequate detriments ,no
foreign body may closed primarily

• Closed wound with minimum tension

• Delayed primary closure can be perform

after several days of dressing