Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Wound Infection, Postoperative


Related Terms

  • Nosocomial Infection

Differential Diagnosis

Specialists

  • General Surgeon
  • Infectious Disease Internist

Comorbid Conditions

  • Cancer
  • Decreased blood volume
  • Diabetes
  • Hypothermia
  • Immune system disorders
  • Malnutrition
  • Other infection
  • Vascular disease

Factors Influencing Duration

The type and extent of the infection, its treatment, the presence of complications, and the individual response to treatment will influence the length of disability. In addition, those of advanced age or those who smoke have prolonged wound healing that might influence the length of disability.

Medical Codes

ICD-9-CM:
998.5 - Wound Infection, Postoperative
998.51 - Infected Postoperative Seroma
998.59 - Other Postoperative Infection; Intra-abdominal Postoperative; Stitch Postoperative; Subphrenic Postoperative; Wound Postoperative; Septicemia Postoperative
998.6 - Persistent Postoperative Fistula

Overview

Postoperative wound infection is an infection in the tissues of the incision and operative area. It can occur from 1 day to many years after an operation but commonly occurs between the fifth and tenth days after surgery.

Wound infection results from microbes flourishing in the surgical site because of poor preoperative preparation, wound contamination, poor antibiotic selection, or the inability of an immunocompromised patient to fight off infection. Contamination of the wound is present to some extent in all incisions. A setback in recovery such as malnutrition, cardiac failure, or decreased oxygen to the tissues will weaken the individual and allow the infection to take hold.

There are four categories of wound contamination. They include clean wounds with no gross contamination, lightly contaminated wounds (stomach or biliary surgeries), heavily contaminated wounds (intestinal surgeries), and infected wounds in which infection is obviously present prior to the surgical incision.

Abdominal surgeries, surgeries lasting over 2 hours, contaminated operations, and the presence of multiple (more than 3) diagnoses in the individual present the highest risk. Generally, factors increasing an individual's risk include malnutrition, decreased blood volume, lengthy preoperative stay, hypothermia, poor tissue perfusion, diabetes, and the use of immunosuppressants such as steroids. Certain wound characteristics may also factor into surgical site infection (SSI), including dead tissue, poor skin preparation, and wound drains. Additionally, conditions surrounding the surgery may account for added risk. Among them are surgical technique, length of surgery, wound site contamination, infection among the surgical staff, and instrument contamination. Preoperative antibiotics, good isolation techniques and delayed suturing of contaminated or infected wounds will lower the risk of postoperative wound infection.

Incidence and Prevalence: Postoperative wound infections account for 14% to 16% of the 2 million nosocomial infections in the US, and 77% of the deaths of surgical patients can be traced back to surgical wound infection (Singhal). A study sponsored by the Centers for Disease Control and Prevention (CDC) suggests that 33% of wound infections can be prevented by careful attention to technique (Massanari 1362). With doctors performing over 45 million surgeries each year in the US, even small improvements will produce significant results. By implementing corrective changes to reduce the occurrence of postoperative wound infection by even one-quarter of 1%, hospitals could prevent over 100,000 infections each year (Owings).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Advanced age and obesity increase an individual's risk of having infection at the surgical site.

Source: Medical Disability Advisor



Diagnosis

History: The individual will complain of increased pain in the incision and operative area. Individuals may report feeling feverish or chilled.

Physical exam: The cardinal signs of wound infection are one or more of the following: pain, tenderness, localized swelling, redness, or heat. The examining physician may notice swelling along the incision that causes increased tightness of the sutures. Lightly feeling (palpating) the wound may reveal hard, warm areas that the patient reports as being tender. The doctor may cut the sutures to allow further inspection of a portion of the incision. The individual will often guard the incision during movement.

Tests: Cultures of wound drainage are taken. A complete blood count (CBC) and erythrocyte sedimentation rate may be done. Other tests include identifying specific proteins on the infective organism using immunoassay techniques or looking for specific antibodies. Laboratories may now use RNA or DNA sequencing studies and polymerase chain reaction (PCR) assays to discover the offending organism, and ultrasound studies may point to the necessity for wound drainage.

Source: Medical Disability Advisor



Treatment

Antibiotics will be given by mouth or intravenously. The incision may be opened and allowed to drain. Any foul-looking tissue or debris will be removed. If the wound is deep, it may be packed with sterile gauze. Some wounds may be treated with physical therapy using a whirlpool or hot bath (Hubbard tank) to help remove destroyed tissue and foster wound healing. Periodic evaluation of the wound and wound cleansing will be done. When it appears the infection has resolved (approximately 2 weeks), the wound may be closed with stitches or allowed to fill in gradually with scar tissue.

Source: Medical Disability Advisor



Prognosis

Postoperative wound infections may make any illness more severe and result in a poor surgical outcome. With appropriate treatment (antibiotics and/or wound drainage), the infection may clear, and the incision may heal. However, healing will be more prolonged than normally expected for the type of surgery performed. Without treatment, there is a substantial risk of the infection spreading systemically, causing associated overwhelming infection, tissue deformity and destruction, and possibly death.

Source: Medical Disability Advisor



Complications

Wound infection can cause separation of the wound layers, incisional hernias, abscesses, and tissue destruction (gangrene or necrotizing fasciitis), which can result in physical and/or functional deformity. Bacteria from the infection can spread, causing an overwhelming, life-threatening, systemic infection (sepsis).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions will depend on the severity and location of the postoperative infection. In many cases, lifting and strenuous activity will be restricted for a period of time, and a support device may need to be worn over the incisional area during certain activities.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Has individual had a recent surgical procedure?
  • Does individual have conditions that may place him/her at higher risk for a postoperative wound infection, such as abdominal surgery, lengthy surgery, or immune system disorders?
  • Does individual have symptoms characteristic of a postoperative wound infection, such as unusual incisional pain, redness, swelling, drainage, or fever and chills?
  • Was an elevated white blood cell count noted?
  • Was wound culture positive?
  • If the diagnosis was unclear, were other conditions such as suture abscess, hematoma, seroma, granuloma, or other infection considered in the differential diagnosis?

Regarding treatment:

  • Have appropriate antibiotics been administered (i.e., antibiotics that are specific for the bacteria that was cultured from the wound)?
  • Was the wound opened and allowed to drain?
  • Has individual completed the full course of antibiotics?
  • Does individual show signs of persistent infection, such as redness or drainage around the wound? If so, was the wound recultured to determine if the bacteria are resistant to the current antibiotic therapy?

Regarding prognosis:

  • Did individual receive prompt treatment?
  • Did adequate time elapse for complete recovery?
  • Are there signs of systemic infection such as fever, rapid heart rate, chills, and fatigue? If so, were they addressed in the treatment plan?
  • Does individual have associated complications, such as wound dehiscence, incisional hernias, abscesses, tissue destruction, or systemic infection, that may affect recovery and outcome? Were complications addressed promptly and appropriately in the treatment plan?
  • Were appropriate specialists consulted (infectious disease specialist, intensivist)?
  • Does individual have any underlying conditions (diabetes, vascular disease, cancer, malnutrition, immune suppression, or other areas of infection) that may affect ability to recover? Were these conditions addressed in the treatment plan?

Source: Medical Disability Advisor



References

Cited

Massanari, R. Michael, and Richard P. Wenzel. "Hospital Infection Control." Internal Medicine. Ed. Jay H. Stein. 5th ed. St. Louis: Mosby, Inc., 1998.

Owings, M. F., and L. J. Kozak. "Ambulatory and Inpatient Procedures in the United States, 1996." Vital Health Statistics 139 Nov (1998): 1-119.

Singhal, Hemant, and Charles Zammit. "Wound Infection." eMedicine. Eds. Brian James Daley, et al. 23 Jul. 2002. Medscape. 3 Nov. 2004 <http://emedicine.com/med/topic2422.htm>.

Source: Medical Disability Advisor






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