Nadhilla Nurayu L. 030.08.

170

Medical Faculty Trisakti University

RSUD Bekasi

SSI Definition

Inflammation and Bacteria

Incision:

-Release tissue factor

-Disrupt circulation -Active coagulating protein

-Damage endhotelium
-Exposed collagen

-ADP release
-Platelets aggregation

Inflammation and Bacteria

Hemostasis inflammation Vasodilation Permeability Edema End products: chemmoattractant Coagulation cascade: precipitation of fibrin (natural dressing) Vasoactive phase followed by phagotic one:

-Neutrophils at 12 hours
-Monocyte at 1-2 days

Immune Response to Bacteria

Risk Factors

Determinants of Infection
Surgical Site

Bacteria

Host Defense Mechanism

Bacteria
Inoculum Virulence

Surgical Site
Hematoma Foreign bodies Dead tissue Dead space

The Host
Age Immune deficiency Hypoalbuminemia Hypoxemia Hyperglycemia Smoking Malnutrition Hypothermia Existing infection Transfussion Obesity

Wound Classification
I. Clean II. Clean-contaminated III: Contaminated IV: Dirty

Hyperglycemia
Fluid and electrolyte disturbances Impairment of host defenses: - Decreased polymorphonuclear - Leukocyte mobilization - Chemotaxis

- Phagocytic activity related to hyperglycemia

Increase infection

risk

Glucose Concentration
Until 2001, hyperglycemia (blood glucose concentrations up to 220 mg/dl) had been tolerated in critically ill

- high blood glucose concentrations were believed to be a normal physiologic reaction in stressed patients
- excess glucose is necessary to support the energy needs of glucosedependent organs

- the true significance of short-term hyperglycemia was not known.

The Effects of Hyperglycemia on The Immune System

Reference
1.http://www.worldwidewounds.com/2005/september/Gottrup/images/ssi_fi gure_1.jpg

2.http://www.cdc.gov/hai/ssi/ssi.html
3.http://www.med.umich.edu/surgery/mast/r_surgwoundclass.html 4.http://www.ncbi.nlm.nih.gov/pubmed/16006275 5.http://www.medscape.com/viewarticle/507661_3