Which is a clean surgery -
Ans. is 'a' i.e., Hernia surgeryo Surgical site infections or also k/a wound infectionsAre infections of the tissue, organs or spaces exposed by surgeons during performance of an invasive procedure.They are classified as belowClassification of Surgical WoundsClean Wound (Class I)o Include those in which no infection is present: only skin microflora potentially contaminate the wound.No hollow viscus is entered. No inflammationo Examples : Hernia repair, breast biopsyClean/con taminated wounds (Class II)o Include those in which a hollow viscus such as the respiratory, alimentary or genitourinary tracts with indigenous bacterial flora is opened, but under controlled circumstances without significant spillage of contents. No inflammation.o Examples : Cholecystectomy, elective GI surgery.Contaminated wounds (Class 111)o Include open accidental wounds encountered early after injury, those with extensive introduction of bacteria into a normally sterile area of the body due to major breaks in sterile technique (eg. open cardiac massage); uncontrolled spillage of viscus contents such as from the intestine. Inflammation is apparento Examples : Penetrating abdominal trauma, large tissue injury, enterotomy during bowel obstructionDirty wounds (Class IV)o Include traumatic wounds in which a significant delay in treatment has occurred and in which necrotictissue is present. Includes wounds in which pus is present. Includes those wounds created to access aperforated viscus accompanied by a high degree of contamination. Severe in flammation is seeno Examples : Perforated diverticulitis, necrotizing soft tissue infection.o Various steps are described for the prevention of SSIs, but we will discuss those related to use of antibiotics only.Use of antibiotics as prophylaxis of SSIsWound classAntibiotics ProphylaxisClass IControversial, most surgeons do not giveClass IDProphylactic antibiotics givenClass HProphylactic antibiotics givenClass HI & IVProphylactic as well as therapeutico About prophylactic antibiotics points to know are -By definition prophylaxis is limited to the time prior to and during the operative procedure - "To be most effective the prophylactic antibiotic agent should be administered intravenously before the incision is made jo that the tissue levels are present at the time the wound is created and exposed to the bacterial contamination. A good time to administer the preoperative dose is when the patient arrives in the operating room. " -- SabistonThere is no evidence in support of post operative doses of antibiotics. Post operative antibiotics increase the cost and promote the development of drug resistant organisms and pseudomembranous colitis.o About option 'd'Local irrigation with antibiotics, in a patient on systemic antibiotics is controversial but definitely not contraindicated.More points to remember about SSIso Pre op. hair shaving increases the rate of SSIs.o For colorectal surgery, bowel preparation is done + oral antibiotics (neomycin + metronidazole) is given.(Ref: Sabiston 18/e p 332)Most common infecting organismsStaphylococcus aureus and coagulase-negative staphylococcus are the most common bacteria found in SSIs(Sabiston 18/e 331)But in cases of GIT operations the most common agents are Enterobacter species & E. coli.(Ref: Sabiston 18/ e, p301)
Hernia surgery
Gastricsurgeru
Cholecystectomy
Rectal surgery'
Hernia