Principles of Infection

Prevention and Treatment

 Case 1
A 69-year-old woman is admitted complaining
of right upper quadrant(RUQ) pain. She is
known to have gallstones, found incidentally
during an ultrasound for uterine fibroids.
Subsequently to the diagnosis, she had an
attack of biliary colic requiring an outpatient
visit to the emergency room. Her blood tests
in the ER revealed elevated fasting blood
glucose (240mg/dl). How to deal with this
case?
 Case 2
You are a 6th year medical student beginning your
clerkship. The chief resident ordered you to come
to the OR to help in an emergency operation.
When you reached the operating room, you were
given a scrub suit, overhead and overshoes.
Some surgeons were using overshoes. while others
were not.
Inside the OR, the surgeon and his chief resident
were already at the operating table, had washed
their hands for less than 2 minutes. You were left
to scrub alone. Which solution should you use?
and For how long should you scrub?
 Case 3
qAn obese, hypertensive 55-year-old man had an
emergency colectomy for perforated diverticular disease.
qDuring the surgery, the sigmoid colon was perforated and
surrounded by feculent material, omentum and small
bowel loops.
qAn end colostomy was constructed after resection of the
diseased colon. The distal end of the colon was closed
with a stapler (Hartmann’s procedure). The wound was
closed, including the skin.
q His preoperative blood sugar was 340mg/dL.
qNow, on postoperative day 3, he is feverish 39°C and his
pulse is 110 beats/min. The wound is erythematous ,
swollen and tender.
 Objectives (to know)
1. Phases and types of wound healing.
2. Types of wounds.
3. Diagnosis and management of wound
infection.
4. Prophylactic antibiotics(proper timing,
spectrum, operative procedures require
prophylactic antibiotics.
5. To learn about the proper conduct in the
Operating Room (OR) and procedures done to
prevent infection.
 infection control in surgical patients should be considered in
three parameters:
The first parameter: patient’s Medical condition.
qProper control of the medical conditions should be done.
qSmoking should be stopped.
The second parameter: the operative environment.
follow the appropriate conduct in the OR in order to
minimize contamination.
The third parameter :the microbial factor:
Transmission of resistant strains or particular infestation by
highly virulent organisms are important factors. So, the
timing of prophylactic antibiotics and possible re-dosing
should be considered.
qThe wound needs to be assessed concerning signs of
infection like; wound erythema and tenderness.
qFever, elevated white blood cell count are important
parameters.
qAn early diagnosis of postoperative wound infection is
helpful, as delayed diagnosis and management can result in
devastating, if not life-threatening complications.