The path of endogenous infection into the wound. The main routes of infection into the surgical wound

The skin and mucous membranes are isolated internal environment from the outside and reliably protect the body from the penetration of microbes. Any violation of their integrity is an entry point for infection. Therefore, all accidental wounds are obviously infected and require mandatory surgical treatment. Infection can occur from the outside (exogenous) by airborne droplets(when coughing, talking), by contact (when touching the wound with clothing, hands) or from the inside (endogenous). Sources of endogenous infection are chronic inflammatory diseases skin, teeth, tonsils, ways of spreading infection - blood or lymph flow.

As a rule, wounds become infected with pyogenic microbes (streptococci, staphylococci), but infection can also occur with other microbes. It is very dangerous for a wound to become infected with tetanus bacilli, tuberculosis, gas gangrene. Warning infectious complications in surgery is based on the strictest adherence to the rules of asepsis and antiseptics. Both methods represent a single whole in the prevention of surgical infection.

Antiseptics - a set of measures aimed at destroying microbes in the wound. There are mechanical, physical, biological and chemical methods of destruction.

Mechanical antiseptics includes conducting an initial surgical treatment wounds and its toilet, i.e. removal of blood clots, foreign objects, excision of non-viable tissue, washing of the wound cavity.

Physical method is based on the use of ultraviolet radiation, which provides bactericidal effect, overlay gauze bandages, which absorb wound discharge well, dry the wound and thereby contribute to the death of microbes. The same method involves the use of concentrated saline solution(law of osmosis).

Biological method based on the use of serums, vaccines, antibiotics and sulfonamides (in the form of solutions, ointments, powders). Chemical method The fight against microbes is aimed at the use of various chemicals called antiseptics.

Drugs used against pathogens of surgical infections can be divided into 3 groups: disinfectants, antiseptics and chemotherapy. Disinfectants substances are intended primarily to destroy infectious agents in the external environment (chloramine, sublimate, triple solution, formaldehyde, carbolic acid). Antiseptic products are used to destroy microbes on the surface of the body or in serous cavities. These drugs should not be absorbed in significant quantities into the blood, as they can have a toxic effect on the patient’s body (iodine, furatsilin, rivanol, hydrogen peroxide, potassium permanganate, brilliant green, methylene blue).

Chemotherapy the drugs are well absorbed into the blood when in various ways administration and destroy microbes in the patient’s body. This group includes antibiotics and sulfonamides.

By clinical course and pathological changes in tissues, surgical infection is divided into nonspecific and specific.

Nonspecific surgical infections include:

1) purulent, caused by various pyogenic microbes - staphylococci, gonococci, streptococci, dysentery bacillus, pneumococci, etc.;

2) anaerobic, caused by microbes that reproduce without access to oxygen - Cl. Perfringens, Cl. oedematiens, septic vibrio, Cl. histoliticus, etc. These microbes are facultative anaerobes that can reproduce in both aerobic and anaerobic conditions. In addition, there are obligate anaerobes that reproduce only without access to oxygen. In the presence of oxygen they die. They are called non-clostridial. These include anaerobic staphylococci, streptococci, actinomycetes, etc. These non-sporogenous microbes cause pleurisy, abscesses of the lung, liver, brain, peritonitis, sepsis, etc.;

3) putrefactive, caused by both anaerobic (Cl. sporogenes, Cl. tertium, etc.) and aerobic (Escherichia coli, B. proteus vulgaris, streptococcus faecalis, etc.) putrefactive microorganisms.

Specific surgical infection causes erysipelas, tetanus, diphtheria and scarlet fever wounds, anthrax, bubonic plague, tuberculosis, syphilis, leprosy and other diseases.

Depending on the nature of the pathogen and the body’s response to the development of the disease process, surgical infection is divided into acute and chronic.

Acute surgical infection is often characterized by a sudden onset and a relatively short-term course.

Chronic nonspecific infection develops from acute infection in the event that she acquires chronic course (chronic osteomyelitis, pleurisy and other diseases). A chronic specific infection can also begin initially (joint tuberculosis, actinomycosis, syphilis and other specific diseases).

In both acute and chronic surgical infections, local symptoms and often local and general manifestations.

Surgical infection penetrates the wound through exogenous and endogenous routes.

In the first case, the infection enters the wound from the outside - by air, droplet, contact and implantation. With the airborne route of penetration, airborne microbes enter the wound; with drip - microbes contained in drops of saliva, mucus, isolated from oral cavity or from the nose when talking, coughing, sneezing. Contact route - when the infection enters the wound through contact with another person. If the infection enters the wound from objects inserted into it (drains, turundas, napkins, etc.) - the implantation route.

Endogenous pathway penetration consists of infection entering the wound directly from the patient himself. In this case, the infection can enter the wound from the skin or mucous membrane of the patient or from a dormant inflammatory focus (tuberculosis) through the lymphatic or blood vessels.

Ways of infection entering the wound

The skin and mucous membranes isolate the internal environment from the external and reliably protect the body from the penetration of microbes. Any violation of their integrity is an entry point for infection. Therefore, all accidental wounds are obviously infected and require mandatory surgical treatment. Infection can occur from the outside (exogenous) by airborne droplets (when coughing, talking), by contact (when touching the wound with clothing, hands) or from the inside (endogenous). Sources of endogenous infection are chronic inflammatory diseases of the skin, teeth, tonsils, and the route of infection spread is the blood or lymph flow.

As a rule, wounds become infected with pyogenic microbes (streptococci, staphylococci), but infection can also occur with other microbes. Infection of a wound with tetanus bacilli, tuberculosis, and gas gangrene is very dangerous. Prevention of infectious complications in surgery is based on strict adherence to the rules of asepsis and antisepsis. Both methods represent a single whole in the prevention of surgical infection.

Antiseptics - a set of measures aimed at destroying microbes in the wound. There are mechanical, physical, biological and chemical methods of destruction.

Mechanical antiseptics includes carrying out primary surgical treatment of the wound and its toilet, i.e., removal of blood clots, foreign objects, excision of non-viable tissue, washing of the wound cavity.

Physical method is based on the use of ultraviolet irradiation, which has a bactericidal effect, and the application of gauze dressings, which absorb wound fluid well, dry the wound and thereby contribute to the death of microbes. The same method involves the use of a concentrated saline solution (the law of osmosis).

Chemotherapy the drugs are well absorbed into the blood through various methods of administration and destroy microbes in the patient’s body. This group includes antibiotics and sulfonamides.

Conditions for the development of infection in the body.

1. Decrease in the body’s defenses (during cooling, blood loss, severe infectious diseases, fasting, hypovitaminosis).

2. High virulence of the microorganism.

3. Large dose infection.

A special place is occupied by “dormant infection”, which manifests itself clinically with a decrease in protective forces.

« Entrance gate"- the path by which a microorganism enters the human body, not necessarily through a wound (food, water, contact, wound).

It enters the wound in two main ways:

1. Exogenous route- from external environment:

a) air

b) contact

c) drip

d) implantation

Contact path has the greatest practical significance, because In most cases, wound contamination occurs through contact. A typical example of a contact infection is a wound received on the street or in a field. In these cases, the object that caused the wound (car wheel, shovel, stone, etc.) is covered with dust or earth and contains significant amount microorganisms, including such dangerous ones as the tetanus bacillus or the gas gangrene bacterium. Microbes that penetrate the wound enter the deepest parts of it and cause the wounds to fester. Microbes can get into surgical wounds from the surgeon's hands, instruments and dressings if they were not sterile. Prevention of contact infection is the main task of operating nurses and surgeons.

By implantation the infection is introduced deep into the tissues through injections or together with foreign bodies(shards, chips, scraps of clothing). In peacetime, implantation infection is most often associated with suturing and implantation of prostheses. Prevention of implantation infection is carried out by extremely careful sterilization of suture threads, nylon mesh and other objects intended to be left in the tissues of the body. Impregnation of implanted threads or prostheses with antiseptic substances is also used. An implantation infection can manifest itself after a long period of time after surgery or injury, occurring as a “dormant” infection. In these cases, suppuration around sutures, splinters or prostheses develops after the weakening of the body's defenses, due to some disease or injury. Implantation infection is especially dangerous during tissue and organ transplant operations, when protective forces the body is specifically suppressed special drugs, immunosuppressants that inhibit the body’s response to foreign tissue, including the introduction of microbes. In these cases, some types of bacteria that usually do not cause suppuration become virulent.

Air route– infection of the wound by microbes from the operating room air is prevented by strict adherence to the operating room regime.

drip path occurs when small droplets of saliva get into the wound and fly through the air when talking.

2. Endogenous pathway:

a) hematogenous

b) lymphogenous

c) contact

Sources of endogenous infection are often carious teeth, inflammatory processes in the oropharynx and nasopharynx, pustular skin formations, etc. In this case, the infection is brought into the wound from an internal source through the blood or lymph flow. Through contact, the infection spreads to a neighboring organ.

According to the types of respiration, all microorganisms are divided into three groups:

aerobic microbes, living and developing only in the presence of oxygen;

anaerobic microbes, existing only in an oxygen-free environment;

facultative anaerobic microbes, capable of existing both in the presence of oxygen and without it.

Depending on the nature of the microbes, the following are distinguished: types of wound infections:

Purulent (pyogenic) infection . Pathogens: staphylococci, streptococci, diplococci, gonococci, Escherichia coli and typhoid bacilli, Pseudomonas aeruginosa and some others. Pyogenic microbes are found in large numbers on objects around us, in the air and especially in pus, feces, etc. If they enter the human body, then in the presence of special predisposing conditions they can cause the appearance and development of a wide variety of acute purulent diseases. If they get to wound surface, then its suppuration occurs with possible further spread of the infection.

Anaerobic infection Pathogens: microbes that cause the development of tetanus when they enter a wound, malignant edema bacillus, anaerobic phlegmon and gangrene, tissue-dissolving bacillus. Anaerobic microbes They are found mainly in manured soil, so contamination of wounds with soil is especially dangerous.

Entry into the human body occurs in various ways:

1) upon contact with any object on the surface of which there are microbes ( contact infection ). This is the most common and most important view wound infection;

2) when saliva or mucus gets into the wound when talking, coughing, sneezing ( droplet infection);

3) when microbes enter the wound from the air (air infection).

Specific infection. Pathogens: Loeffler's bacillus (wound diphtheria), hemolytic streptococcus (wound scarlet fever), etc.

Sources of infection wounds with microorganisms:

Exogenous source , when an infection enters the body from the external environment:

From the air - airborne infection;

From objects in contact with the wound - contact;

With saliva and mucus secreted by staff when talking and coughing - drip;

From objects left in tissues, such as implantation sutures and tampons.

Endogenous infection located in the patient’s body (on the skin, in respiratory tract, intestines) and can be brought into the wound directly during or after surgery through the blood and lymphatic vessels.

However, for the rapid and unhindered proliferation of microbes, certain conditions are necessary: weakening of the person by blood loss, radiation, cooling and other factors. is caused by the action of In other conditions, the body's defenses operate and the pathological process does not develop.

End of work -

This topic belongs to the section:

Fundamentals of medical knowledge

Educational institution.. Vitebsk State University named after P M Masherov.. E D Smolenko..

If you need additional material on this topic, or you did not find what you were looking for, we recommend using the search in our database of works:

What will we do with the received material:

If this material was useful to you, you can save it to your page on social networks:

All topics in this section:

Vitebsk
Publishing house of the educational institution "VSU named after. P.M. Masherov" UDC BBK Published by decision of the scientific and methodological council of the Educational Institution "Vitebsk State

Principles of medicinal care
Forming among the population the skills of providing first aid to sick and injured people at home and at the enterprise, while traveling and on the street is the main task of medical workers

Dosage forms
Dosage forms- these are convenient for practical application forms given to medicines. Currently, many technologies have been developed and put into practice

Types of action of medicinal substances
üDepending on location medicinal substances in the body the effect it has can be local and general. × Local action

Respiratory diseases
TO respiratory system These include organs that perform: pneumatic function (oral cavity, nasopharynx, larynx, trachea, bronchi); gas exchange fun

Acute bronchitis
Bronchitis is called inflammatory process in the bronchi. According to the nature of the course, acute and chronic bronchitis are distinguished. ACUTE BRONCHI

Bronchial asthma
Asthma is paroxysmal shortness of breath. Depending on the mechanism of its development (pathogenesis), asthma can be bronchial and cardiac. BRONCHIAL AST

Diseases of the cardiovascular system
General signs diseases of the circulatory system: Palpitation is a feeling of rapid and intense heart contractions. Healthy person

Acute vascular insufficiency
Acute vascular insufficiency- this is a drop in tone blood vessels, accompanied sharp decline blood pressure. It manifests itself in 3 clinical forms:

Digestive diseases
Among the most typical manifestations diseases gastrointestinal tract include: Pain, varying in: × in nature: dull and sharp, aching and dire

Etiology and pathogenesis
Exogenous factors: × errors in nutrition (poor quality food; overeating, especially large meals at night; drinking alcohol, spicy seasonings and etc.); ×

Treatment
Ø gastric lavage warm water or chamomile infusion; Ø the intestines are cleared with a cleansing enema and/or a saline laxative; Ø bed r

Drug therapy
For treatment peptic ulcers a lot has been proposed various drugs, different in composition and form. They are divided into 6 main groups: antacids and adsorbents

Clinical picture
The main objective signs gastrointestinal bleeding are bloody vomiting and tarry stools. The color of the vomit depends on the location of the pathological process.

Acute cholecystitis
Etiology and pathogenesis. Main reason acute inflammation gallbladder is the penetration of an infectious agent into it (escherichia coli, Pseudomonas aeruginosa, staphylococcus, ent

Etiology and pathogenesis
The causes of cholelithiasis are: × hereditary characteristics lipid metabolism; × metabolic diseases (obesity, diabetes, atherosclerosis, gout); ×

Etiology and pathogenesis
Insulin-dependent diabetes mellitus develops in people with a genetic predisposition to this disease. Upon contact with β-tropic viruses ( measles rubella, epidemic mumps

Coma in patients with diabetes mellitus
Diabetic ketoacidotic coma is one of the most severe complications diabetes mellitus, occurs as a result of increasing insulin deficiency in the body. Corner violation

Kidney and urinary tract diseases
Diseases of the urinary organs are accompanied by a relatively small number of symptoms. Some of them may long time be asymptomatic, only changes in urine indicate

Pyelitis. Pyelonephritis
Pyelitis is an inflammation of the renal pelvis infectious origin, pyelonephritis - an inflammatory process in the kidneys and renal pelvis. Infection in the pelvis

Antiseptics and asepsis
Modern surgery covers a large number of surgical specialties: general surgery, traumatology (the study of damage), neurosurgery (the study of care

Antiseptics
ANTISEPTICS is a complex of therapeutic- preventive measures aimed at destroying microbes in a wound or the body as a whole. Types of antiseptics:

Antiseptic substances
They are called antimicrobial medicines, which are used to combat pathogenic microbes. Types of antimicrobial agents:

Asepsis
ASEPTICA (from the Greek a - denial and septicos - purulent) is a system of preventive measures aimed at destroying microorganisms in order to prevent possible

Anesthesia. Reanimation
Attempts to reduce pain reactions during operations have been made since time immemorial. However, most of the methods and means taken for this purpose were not only effective, but sometimes dangerous for

General anesthesia and its types
Anesthesia (from the Greek narcosis - numbness) is an artificially induced deep dream with loss of consciousness and pain sensitivity, called drugs. To nar

Preparation for anesthesia
Distinguish general training to anesthesia and special medication preparation– premedication. General training includes

Reanimation
RESUME – measures aimed at restoring severely damaged or lost essential vital functions body in order to revive the patient. Carried out at thermal

Bleeding. Transfusion of blood and its substitutes
BLEEDING, hemorrhage (Greek haima - blood and rhagos - torn, torn) - intravital leakage of blood from blood vessels due to a violation of their integrity

Danger of blood loss in children and adults
The blood mass of an adult is 1/13 of body weight, i.e. about 5 l. Circulating blood volume (CBV) depends on body weight, age of a person and is approximately determined by the formula: BCC = m

Methods for temporarily and permanently stopping bleeding
The main means of artificially stopping bleeding are mechanical techniques: Ø Giving the limb an elevated position leads to stopping the bleeding

Agglutinins are special proteins that belong to gamma globulins and are found in blood serum. There are two types of them - α and β
Agglutination reaction is the gluing of red blood cells as a result of the combination of serum agglutinins with agglutinogens of the same name, followed by their dissolution (hemolysis).

Blood transfusion and plasma replacement solutions
Types of blood transfusion: direct transfusion blood - direct injection of blood from the donor vein into the recipient vein with the help of

Complications from blood transfusion
Blood transfusion reactions usually occur without disruption of vital functions. important organs, most often are short-term and disappear in the next few hours without special treatment

Plasma replacement solutions
Plasma replacement solutions are divided into two groups: natural and blood substitutes. Natural substitutes are human blood products: ×

Traumatic shock
TRAUMATIC SHOCK occurs most often and occurs when a large mass of soft tissue is crushed, skeletal bones are fractured, or chest or abdominal cavity, og

The concept of closed damage
DAMAGE (trauma) is anatomical or functional disorders tissues and organs of the body under the influence of external factors. Main types of damage in

Soft tissue bruises
Bruise is a closed injury to tissues or organs without visible anatomical disturbances, resulting from mechanical trauma (a fall or a blow to any hard, blunt object

Sprains and tears of ligaments, tendons and muscles
Sprains and ruptures are damage to soft tissue due to sudden overstrain exceeding physiological limits norms. Most often

Types of dislocations
By origin, dislocations are: congenital; acquired: - traumatic; - pathological. Traumatic

Long-term compartment syndrome
Long-term crush syndrome (traumatic toxicosis) occurs after prolonged compression of a limb during collapses of houses, landslides in the mountains, which could

Drowning
DROWNING is one of the forms of mechanical asphyxia that occurs when a person is immersed in water. Clinical picture. There are three options

Open damage. Surgical infection
OPEN DAMAGES (WOUNDS) WOUND– mechanical damage body tissues with damage to the integrity of the skin or mucous membrane

Acute focal infection
Etiology. Pathogens: pyogenic bacteria (staphylococci, streptococci, coli, pneumococci, Pseudomonas aeruginosa). Clinical picture. Nezav

Infection of the skin and subcutaneous tissue
Furuncle – acute purulent inflammation sebaceous gland and hair follicle. Etiology. The causative agent is staphylococcus. Contributing conditions are non-compliance with hygiene rules,

Acute general infection
SEPSIS – general nonspecific infection, resulting from the spread purulent infection throughout the body or poisoning of the body with waste products

Acute anaerobic infection
GAS GANGRENE is a complication of the wound process, characterized by rapidly occurring and spreading tissue necrosis, necrosis, usually with the formation of gases.

Acute specific infection
TETANUS is an acute specific infection caused by the penetration of tetanus bacillus into the body during open injuries, characterized by lesions nervous system and prot

Burn disease
Burn disease develops after thermal effects (ΙΙ - ΙV degree) on 10-15% or more than 50% of the body surface (for Ι degree burns) with disorder

Frostbite and freezing
FROSTBITE – limited damage to body tissue caused by local action low temperature. FREEZING - overall impact low temperatures

Clinical picture
Local changes manifested by tissue burns at the entry and exit points electric current, ruptures of all layers of tissue. Electrical burns are usually deep, heal slowly, and

Bone fractures
FRACTURE - complete or partial disruption of the integrity of a bone caused by mechanical force or pathological process and accompanying

Closed head injuries
CLOSED CRANIOBRAIN INJURY (CTBI) is accompanied by damage big brain, without violating the integrity skin head and aponeurosis, including fractures of the arch bones or

Fractures of the bones of the vault and base of the skull
Fractures and cracks in the bones of the skull often correspond to areas of bruise or intracranial hematoma. There are open and closed fractures skull bones

Traumatic brain injuries
OPEN CRANIOBRAIN TRAUMA (OCBI) – damage to the skin of the head with damage to the aponeurosis and bones of the skull. Most often found with lacerations and bruises.

Damage to the nose
Damage to the soft tissues of the nose. If the integrity of the skin and mucous membranes is violated, the injury to the nose is considered open. Simultaneous damage to cartilage and bone base nose Per

First aid
Ø Apply aseptic dressing on the injured eye. For penetrating wounds and contusions of the eyes, a bandage is applied to both eyes. Ø Do not rinse damaged eyes. Only

Injuries of the trachea, larynx, large vessels of the neck
Closed injuries include bruises, fractures hyoid bone, cartilages of the larynx and trachea. They arise from a blow from a hard object, a fall, or compression. Signs: celebrating

Spinal column injuries
Closed injury spine and spinal cord constitutes no more than 0.3% of the total amount of all damage. However, the severity of this type of injury and the duration of disability associated with it

First aid
Ø If there is a wound, apply an aseptic bandage. Ø Administer painkillers and cardiovascular medications. Ø Immobilize the spine.

Chest injuries
There are closed and open injuries to the chest. CLOSED chest injuries include bruises, compression, concussions, rib fractures,

Traumatic asphyxia due to chest compression
Traumatic asphyxia is a symptom complex that is caused by temporary cessation of breathing due to sudden compression of the chest during landslides, explosions, and sometimes from multiple

Chest wounds
There are penetrating and non-penetrating chest wounds. Non-penetrating wounds chest - these are wounds in which the integrity of the parietal pleura is not violated.

Diseases and injuries of the abdominal and pelvic organs
THE CONCEPT OF “ACUTY ABDOMEN” Acute stomach- This clinical picture, in which signs of inflammation of the peritoneum or internal bleeding appear. Acute

Clinical picture
According to the clinical course, acute and chronic peritonitis are distinguished. According to their prevalence, there are diffuse (general) and limited peritonitis: Diffuse peritonitis

Closed abdominal injuries
With closed abdominal injuries, there is no disruption of the skin. Etiology. Closed damage arise as a result of any blunt trauma (explosive impact

Abdominal wounds
When the abdomen is wounded, the integrity of the skin is damaged as a result of the use of firearms, bladed weapons, and sharp objects. Clinical manifestations very different

The clinical picture includes relative and absolute signs
Relative signs: increased heart rate, pain on palpation throughout the entire abdomen, muscle tension abdominal wall, positive Shchetkin-Blumberg symptom, dry tongue, thirst. Voltage

Pelvic injuries
Pelvic injuries are divided into open and closed. There are injuries to the soft tissues of the pelvis, fractures of the pelvic bones without damage and with damage to the pelvic organs.

Injuries to the urinary system
Injuries to the kidneys and ureters Closed injuries to the kidneys and ureters occur from a blow to the lumbar region, when falling, exposed to