Prevention of Sepsis Handwashing Skin preparation Tissue Handling

Surgical Drains • Indications: – Prevent accumulation of fluid • Blood • Pus •

Surgical Drains • Types: – Open • Simple (corrugated tubes or sheets) • Can

Surgical Drains • Types – Penrose • Soft rubber tube • Dependent Drainage -

Surgical Drains • Practical Points – Drain must be secured (but removable) – Fluid

Surgical Drains • Removal – Always use aseptic technique – As soon as possible

Surgical Drains • Evidence – Paucity • Remember: No evidence of effect is NOT

Bacteriology Samples • • • Time of pyrexia Pre-antibiotics Sample taken properly (aseptic technique)

U. T. I. % General Population • • • E. Coli Proteus mirabilis Klebsiella

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Prevention of Sepsis • Handwashing • Skin preparation • Tissue Handling – Minimise trauma – Avoid damage to blood vessels • • Minimise blood loss Obliterate dead space Minimise foreign material Antibiotic prophylaxis

Surgical Drains • Indications: – Prevent accumulation of fluid • Blood • Pus • Infected fluids – Prevent accumulation of air/gas – Characterise fluid

Surgical Drains • Types: – Open • Simple (corrugated tubes or sheets) • Can increase the risk of infection in non-infected cases – Closed • Reduce the risk of infection – Passive • Differential pressure or gravity – Active • Suction - low or high pressure (Redivac) – Rubber • Inflammatory - may encourage tract formation – Silastic • Inert

Surgical Drains • Types – Penrose • Soft rubber tube • Dependent Drainage - gravity • Open – Jackson-Pratt • Closed • Collection bulb + low grade suction – Negative Pressure Wound Therapy • Enclosed foam + suction • Healing of large areas by granulation

Surgical Drains • Practical Points – Drain must be secured (but removable) – Fluid drained must be measured (accurately) – Include fluid drained in fluid balance – Monitor changes in character of fluid drained

Surgical Drains • Removal – Always use aseptic technique – As soon as possible • The longer in situ, the greater the risk of infection – When drainage < 25 ml/day – Shortening - gradual removal • Useful when draining part of the body that normally secrete fluid, e. g. peritoneum. – Analgesia may be needed – Send tip to lab. for culture, if available

Surgical Drains • Evidence – Paucity • Remember: No evidence of effect is NOT the same as evidence of no effect. – Not recommended in uninfected or uncomplicated cases. – In complex cases, understand the problem and the benefits to be gained by using a drain. – Remove as soon as possible when job done to avoid introducing infection.

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Bacteriology Samples • • • Time of pyrexia Pre-antibiotics Sample taken properly (aseptic technique) Specimen to lab ASAP (particularly anaerobes) Swabs in transport media Label correctly

U. T. I. % General Population • • • E. Coli Proteus mirabilis Klebsiella Enterococcus Staph spp Pseudomonas % Hospital Population 69 4. 3 4. 7 5. 5 4. 0 11