Nov 18, 2014 herpetic whitlow herpetic whitlow is an intensely painful infection of the hand involving 1 or more fingers that typically affects the terminal phalanx. In the printed or pdf version of this article, author affiliations can be found at the. A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. The most common chronic hand infection in developing countries is hansen disease leprosy. Hand infection in diabetic patients article pdf available in hand surgery 163. A surgical site infection ssi is often caused by bacteria. Oct 22, 2019 a few important guidelines assist in the management of hand infections. The area of erythema should be marked to help document progression of the infection.
The hand can easily be injured during everyday activity or with minor trauma, and small wounds are often overlooked. Infection is one of the most common complication patients face in the days and weeks following surgery, and it is worth the effort to prevent infection whenever possible. Protect the wound with a clean gauze and light bandage for 3 days following surgery change daily or when soiled. Offer surgical treatment strategies for various acute hand infections. Dec 01, 2003 hand infections can result in significant morbidity if not appropriately diagnosed and treated. Page from the department of plastic surgery, northern general hospital, sheffield, uk an audit was designed to analyse the risk factors for developing postoperative wound infection following hand surgery. The complex anatomy of the hand also makes it susceptible to unique infections. Most hand infections are the result of a neglected wound. The incidence of methicillinresistant s aureus mrsa hand infections has gradually increased over the past 2 decades. Superficial infections tend to settle quickly with oral antibiotics and regular dressings. Therefore, it is easily ignored and underestimated resulting in increased morbidity among the diabetic population. The problem area selected for the second global patient safety challenge, in 20072008, was the safety of surgical care. Minimum expectations for safe care and is intended to assist in the assessment of infection control programs and practices in outpatient settings.
Host factors, location, and circumstances of the infection are important guides to initial treatment. Physical therapy is prescribed once the infection has healed and helps the hand regain its original range of motion. Risk factors for development of nosocomial mrsa infections include intensive care unit hospitalization, longterm antibiotic treatment, surgical. The treatment for infections to the hand may include rest, use of heat, elevation, antibiotics, and surgery. Infection prevention checklist for outpatient settings this checklist is a companion to the guide to infection prevention for outpatient settings. M tuberculosis used to be the most common cause of chronic hand infection but has been surpassed by nontuberculous mycobacteria.
Pdf despite modern diagnostic methods, surgical advances and antibiotics evolution, acute closedspace hand infections still remain a therapeutic. Commonly involves thumb and index fingers risk factors genital herpes in self or partner. Surgical handrubbing technique handwash with soap and water on arrival to or, after having donned theatre clothing caphatbonnet and mask. The typical infections that occur in the hand include subcutaneous abscesses, septic joints, and cellulitis.
Hand and wrist usually appear normal, but may show thenar atrophy. Oct 31, 2018 most hand infections are bacterial and are the result of minor wounds that have been neglected. Presence of any purulant discharge through drains any positive culture findings from intraabdominal samples. Your hands range of motion how much the fingers and hand can bend and straighten will also be tested. Most hand infections are caused by s aureus, and therefore, a firstgeneration cephalosporin eg, cephalexin is usually the first drug of choice.
Listing a study does not mean it has been evaluated by the u. Elevation of the hand and arm and application of a heat pack, along. Patient engagement with surgical site infection prevention. We analyze the clinical course and outcome of hand infection in diabetic patients. Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections ssis remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. Without treatment, the infection may spread to deeper tissues or to organs close to the surgery area. Clean their hands with soap and water or an alcoholbased hand. Hand and wrist usually appear normal, but may show thenar atrophy provocative tests. Anesthesia and other healthcare providers should always refer to their facilitys policy on infection control standard precautions. Challenge in 20052006, was infection associated with health care. After surgery, the hand is wrapped in a bulky dressing. Flexor tendon sheath infection, or pyogenic flexor tenosynovitis is an aggressive, closedspace bacterial infection that can lead to significant morbidity if not effectively managed. This is when tendons in the hand or fingers become swollen and inflamed. Discharge instructions for hand infection surgery wound care.
Infection prevention and control guidelines for anesthesia. Common acute hand infections american family physician. Postoperative infection following hand surgery guidelines for antibiotic use a. Department of plastic and reconstructive surgery, queen marys university hospital.
Our hands are constantly at risk for injury and infection. Hand infections can vary from routine problems treated with oral antibiotics, immobilization, and limited incision and drainage to catastrophic surgical emergencies resulting in significant compromise of hand function. Surgical site infection definition deep incisional organ space infection any infection occuring within postoperative 30 days or within postoperative one year if any implant is left described as. It may develop 10 days to several weeks after surgery. Optimal care requires the clinician to understand this anatomy and how it influences the behavior of. Infection, flexor tendon sheath hand surgery source. However, infections develop in about 1 to 3 out of every 100 patients who have surgery. If surgery cannot be performed immediately or the diagnosis of deep infection is uncertain, immobilization, rest, and elevation of the extremity in combination with. Following surgical treatment of a hand infection, the hand is placed in a splint and elevated. At least one individual trained in infection prevention is employed by or regularly available e. Infection prevention policies and procedures are reassessed at least annually or according to state or federal requirements, and updated if appropriate. Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.
Most patients who have surgery do not develop an infection. Help prevent what are the common signs of healthcare. A surgical site infecion is an infecion that occurs ater surgery in the part of the body where the surgery took place. First, cellulitis must be treated with antibiotics. Infection means more pain, and in the worst cases, hospitalization.
Acute hand infections include felon, paronychia, deepspace infections, septic arthritis, osteomyelitis, and. Swelling, coldness, paleness, or blue color of fingers compare to fingers on your other hand. Very uncommon risks include bleeding with bruising and infection. In the hand, animal or human bites are a common cause of infection. In surgery safety precautions and infection control. Some infections arise spontaneously, others follow quite minor injuries, or even a seemingly trivial scratch. If this problems interferes with your daily life, it may be time to consider surgery. To prevent swelling and stiffness make a full fist and fully straighten the fingers out 10 times. When initial treatment and a postoperative after care are inappropriate. Once the infection has been cured, another surgery to reconstruct the damaged bone may be needed. Infection control staff members use an alcoholbased hand cleaner or wash their hands with soap and water both before and after contact with you. If you arent certain they have cleaned their hands, please ask them to do so.
Some joint infections occur without any known cause. Some of the common symptoms of a surgical site infection are. Whether delaying surgery increases the risk of infection in open hand injuries is an important but unresolved topic. Hematogenous spread of infection from other sites to the hand is rare but can. Most patients who have surgery do well, but a small number will develop an infection in the part of the body operated on. An audit was designed to analyse the risk factors for developing postoperative wound infection following hand surgery. The effect of postoperative rehabilitation for hand infection. Outpatient guide checklist centers for disease control and. Hand infections are common, usually resulting from an untreated injury. Appropriate hand hygiene of hcws remains the most effective strategy to protect patients from healthcareassociated infections and limit the spread of antimicrobial resistant bacteria 31, 33, 34.
Anaerobes are common in instances of intravenous iv drug abuse, in patients with diabetes, and in bite wounds. In this retrospective study, we report on hand infection cases needing surgical drainage in order to assess patient demographics, causation of infection, clinical course, and clinical management. People whose immune systems are impaired are at increased risk for septic joints. The risk ratio rr for surgical site infection was estimated by logistic regression. The initial evaluation and management of hand infection includes a focused history and examination and often involves laboratory evaluation and imaging. The most common complications is that people who have one chalazion are at risk for developing more chalazia in the future. Use an alcoholbased handrub abhr product for surgical hand preparation, by carefully following the technique illustrated in images 1.
Aug, 2012 surgical site infection definition deep incisional organ space infection any infection occuring within postoperative 30 days or within postoperative one year if any implant is left described as. Infection delays healing, can increase scarring and can lead to a much longer recovery for the patient. Optimal care requires the clinician to understand this anatomy and how it. Surgical drainage may be used if there is an abscess in the hand to help remove the collection of pus. This prospective cohort study included 983 consecutive adults with open hand injuries treated surgically over 1 year. Deep infections around the tendons and bones are rare and may need admission to hospital for intravenous antibiotics and further.
National and international recommendations to prevent ssis have been published, including recent. Sep 30, 2014 hand hygiene and hospital acquired infections the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Healthcare workers hands are the most common vehicle for the transmission of healthcareassociated pathogens from patient to patient and within the healthcare environment. Time to surgery for open hand injuries and the risk of. Herpetic whitlow herpetic whitlow is an intensely painful infection of the hand involving 1 or more fingers that typically affects the terminal phalanx. Hand hygiene is the practice of removing microorganisms from hands.
Patient education in orthopedic surgery orthoillustrated. Hand hygiene and hospital acquired infections full text. Twice daily soaks on 50% peroxide and 50% warm water solution. Any signs of infection at the incisions redness, hot to tough, or tenderness. Hand infections are very common and must be properly diagnosed and treated to minimize the potentially devastating functional complications. The diabetic hand infection is less reported in the literature. In addition to the common signs of an hai, a patient with a surgical site infection may have cloudy fluid drain from their surgical wound. Hand hygiene is the most effective way to prevent transmission of infection. Hand hygiene and hospital acquired infections the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Hand infections can result in significant morbidity if not appropriately diagnosed and treated. Performing proper hand hygiene significantly reduces the incidence of infection.
Infections of the hand are a common reason people seek treatment. Hand infection american society for surgery of the hand itchy hands or feet logical images mcp joint arthritis american society for surgery of the hand musicians dystonia dystonia medical research foundation osteoarthritis of the hand american society for. Bacteria may enter a joint through a break in the skin, the bloodstream from another source of infection or as a result from prior surgery. Milk out any remaining fluid through the open wound. The who guidelines for safe surgery, first edition, is intended to be issued as a second edition in 2009. Although antibiotics have led to markedly reduced morbidity, hand infections can result in severe disabilities, including stiffness, decreased range of motion, and contracture, and ultimately may require.
In the printed or pdf version of this article, author affiliations can be. Use an alcoholbased handrub abhr product for surgical hand preparation, by carefully following the technique illustrated in images 1 to 17, before every surgical procedure. Outpatient guide checklist centers for disease control. This campaign established simple, clear standards for hand hygiene, an educational campaign and whos first guidelines on hand hygiene in health care 1.
Yet, compliance with hand hygiene among hcws is persistently substandard with an average of only 38. The purpose of this article is to provide a systematic approach to the diagnosis, evaluation, and treatment of hand infec. You may shower, but keep the dressing dry by covering the area with a plastic bag. Sep 02, 2014 hand infections are common, usually resulting from an untreated injury.
Diabetic hand is a rapid in progression, extensive and severe tissue destruction. In this article, we discuss hand infections in terms of pertinent anatomy. Hand infection, rehabilitation, surgery, hand based splint. Staphylococcus aureus is responsible for most instances of hand infection, followed by streptococcus viridans and betahemolytic streptococci. Superficial infections are common 5% after hand surgery and cause redness, swelling, pain and pus around the stitches. When your problem gets out of hand tenosynovitis one common hand problem is called tenosynovitis. Global guidelines for the prevention of surgical site infection 2 who library cataloguinginpublication data global guidelines for the prevention of surgical site infection. Complications following hand surgery rebecca ayers. May 12, 2017 appropriate hand hygiene of hcws remains the most effective strategy to protect patients from healthcareassociated infections and limit the spread of antimicrobial resistant bacteria 31, 33, 34. At present it is important for countries and organizations to note that the guidelines represent a consensus of international experts and up to date technical information on safe surgery across the world. The most common bacterial and fungal infections in north america are nocardiosis and sporotrichosis, respectively. Infections of the hand and wrist hand specialists in.