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PENANGANAN INFEKSI
PASCA-TRAUMA
PRESENTAN :
MOCHAMAD AHLIDIN FIRDAUS, DR
MUHAMMAD ALDITO RIVALDI, DR
ANNISA NURFITRIANI, DR
ADI WIBISONO S., DR
SYAFIFAH NOVA AMIZA, DRG.
Pendahuluan
incidence approximately 25%.
most trauma-related deaths occur from either
exsanguination or massive injury to the central
nervous system within 24 hours of injury, the leading
cause of later posttraumatic death is infection, usually
manifesting as multiple organ dysfunction syndrome
Temporal Relationships of Trauma Deaths to Causation
Adapted from: Asensio JA, Stewart BM, Murray J, et al.: Penetrating cardiac
injuries. Surg Clin North Am 76:685, 1996.
Trauma patients high risk of infection:
• the host immunosuppressive response to injury
• direct inoculation of wounds by clothing, dirt, or
debris
• inadequate infection control practice under emergency
condition
• blood transfusions
• poor control of blood sugar
Infections following injury
• occur in the injured tissue itself (or an incision made
to treat the injury) or as nosocomial infections, such as
pneumonia or catheter-related blood stream infection
(CR-BSI)
• Among the nosocomial infections, pleuro-pulmonary
infections (e.g., pneumonia, empyema) are more
common than CR-BSIs, which in turn are more
common than urinary tract infections.
Overview of the “Stress Response” to Injury
Activation of the sympathetic nervous system
Extremes of age
Malnutrition
Obesity
Diabetes mellitus
Prior site irradiation
Hypothermia
Hypoxemia
Remote infection
Corticosteroid therapy
Recent operation, especially of the chest or abdomen
Chronic inflammation
Hypocholesterolemia
PREVENTION
Control of Blood Sugar.
• Moderate hyperglycemia (>200 mg/dL) at any time on
the first postoperative day increases the risk of infection
after cardiac and noncardiac surgery.
• The infusion of insulin to keep blood glucose
concentrations <110 mg/dL was associated with a 40%
decrease in mortality among critically ill postoperative
patients, who also had fewer nosocomial infections and
less organ dysfunction
Infection Control
• Hand hygiene
• Universal precautions (i.e., cap, mask, gown, gloves, and
protective eyewear) must be observed whenever there is
a risk of splashing of body fluids (at all times in the
trauma bay)
• Contact isolation
Catheter Care
• appropriate skin cleansing and barrier protection during
insertion,
• proper catheter selection,
• proper dressing of indwelling catheters,
• removal as soon as possible when no longer needed.