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1. How are postoperative complications classified?
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Correct answer:
These can be classified according to the following.
- Local or general complication. Local, involving the operation site itself; general, affecting any of the other systems of the body, e.g. respiratory, urological or cardiovascular complications.
- Time of occurrence postoperatively. Immediate, within the first 24 hours; early, within the first 3 weeks; late, any subsequent period, often long after the patient has left hospital. In addition, when considering the factors contributing to any postoperative complication the following classification should be used: preoperative, factors already existing before the operation is carried out; operative, factors that come into play during the operation itself; postoperative, factors introduced after the patient's return to the ward.
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2. What is the incidence of wound infection after surgical operations related to?
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Correct answer:
This depends on the type of operation.
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3. Why is haemolytic Streptococcus not usually a common infective agent following operation?
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Correct answer:
This is usually penicillin sensitive.
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4. Which two antibiotic-resistant organisms are a major worry in terms of postoperative infection?
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Correct answer:
Meticillin-resistant Staphylococcus aureus (MRSA) and the vancomycin-resistant Enterococcus.
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7. What preoperative patient factors predispose to postoperative complications?
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Correct answer:
Local factors include pre-existing infection, e.g. a perforated appendix or an infected open fracture. General factors include being a nasal carrier of staphylococci or having a skin infection, e.g. a crop of boils, as well as malnourishment and immunosuppression.
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8. What operative factors predispose to postoperative complications?
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Correct answer:
These are lapses in theatre technique, e.g. failure of adequate sterilization of instruments, the surgeon’s hands or dressings. There may be nasal or skin carriers of staphylococci among the nursing and surgical staff. Wound infections are especially common when the alimentary, biliary or urinary tract is opened during surgery, allowing bacterial contamination to occur. Wounds placed in poorly vascularized tissue, such as an amputation stump, are also prone to infection, in particular gas gangrene from anaerobic clostridial contamination, since necrotic tissue is a good medium for bacterial growth.
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9. What are the postoperative factors which predispose to postoperative infection?
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Correct answer:
- Cross infection; from elsewhere on the patient’s body or from other infected cases in the ward during dressing changes or wound inspection.
- New infection; owing to contamination of the wound from the nose or hands of the surgical or nursing staff. The use of basic infection control and hygiene discipline cannot be overstated. Healthcare professionals, be they nurses, doctors, ward clerks or cleaners, have a duty of care for their patients. This includes avoidance of cross-contamination or infection by basic hand washing before touching any patient or whenever entering their bed space, and isolation of any patient infected with a contagious or dangerous organism such as meticillin-resistant
Staphylococcus aureus, vancomycin-resistant Enterococcus, extended spectrum beta-lactamases or Clostridium difficile.
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10. How would you manage a patient with a postoperative wound infection?
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Correct answer:
Prophylaxis requires scrupulous theatre and dressing technique, the isolation of infected cases and the elimination of carriers with colds or septic lesions among the medical and nursing staff. Established infection is treated by drainage; antibiotics are given if there is, in addition, a spreading cellulitis. Open wounds may benefit from the use of a vacuum-assisted closure device.
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12. What would be a sensible antibiotic to use prophylactically following an open fracture or a penetrating wound?
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Correct answer:
Prophylaxis against clostridial infection.
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13. What would be a cause of mucus in the stools?
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Correct answer:
Pseudomembranous colitis, which is the result of antibiotic-associated enterocolitis.
