TAILIEUCHUNG - Chapter 125. Health Care– Associated Infections (Part 6)

The epidemic of mad cow disease, centered in the United Kingdom, and associated human cases of variant Creutzfeldt-Jakob disease (Chap. 378) caused by disinfection-resistant prion agents have led to revised recommendations for decontaminating surgical instruments, especially those used for operations on the central nervous system or in patients with dementing illness of unknown etiology. The process of diagnosing and treating wound infections begins with a careful assessment of the surgical site in the febrile postoperative patient. Clinical findings range from obvious cellulitis or abscess formation to subtler clues such as a sternal "click" following open heart surgery. . | Chapter 125. Health Care- Associated Infections Part 6 The epidemic of mad cow disease centered in the United Kingdom and associated human cases of variant Creutzfeldt-Jakob disease Chap. 378 caused by disinfection-resistant prion agents have led to revised recommendations for decontaminating surgical instruments especially those used for operations on the central nervous system or in patients with dementing illness of unknown etiology. The process of diagnosing and treating wound infections begins with a careful assessment of the surgical site in the febrile postoperative patient. Clinical findings range from obvious cellulitis or abscess formation to subtler clues such as a sternal click following open heart surgery. Diagnosis of deeper organ-space infections or subphrenic abscesses requires a high index of suspicion and the use of CT or MRI. Diagnosis of infections of prosthetic devices such as orthopedic implants may be particularly difficult and often requires the use of interventional radiographic techniques to obtain periprosthetic specimens for culture. The most common pathogens in postoperative wound infections are S. aureus coagulasenegative staphylococci and enteric and anaerobic bacteria. In rapidly progressing postoperative infections which manifest within 24-48 h of a surgical procedure the level of suspicion regarding group A streptococcal or clostridial infection Chaps. 130 and 135 should be high. Treatment of postoperative wound infections requires drainage or surgical excision of infected or necrotic material and antibiotic therapy aimed at the most likely or laboratory-confirmed pathogens. Infections Related to Vascular Access and Monitoring Intravascular devices are common causes of local site infection and cause up to 50 of nosocomial bacteremias central vascular catheters CVCs account for 80-90 of these infections. National estimates indicate that as many as 200 000 bloodstream infections associated with CVCs occur each year in the United .

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