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.

Any Questions?

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.

• E. Coli 69• Proteus mirabilis 4.3• Klebsiella 4.7• Enterococcus 5.5• Staph spp 4.0• Pseudomonas 11

% General Population % Hospital Population