Prevention of Sepsis
• Handwashing
• Skin preparation
• Tissue Handling
– Minimise trauma
– Avoid damage to blood vessels
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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
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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
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E. Coli
Proteus mirabilis
Klebsiella
Enterococcus
Staph spp
Pseudomonas
% Hospital Population
69
4.3
4.7
5.5
4.0
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