Antibiotics as prophylaxis Flashcards
Define prophylaxis
Is the treatment given or action taken to prevent disease
Define surgical site infections
Infection of a surgical wound or involving the body cavity, bones, joints, meninges or other tissues involved in the operation
also includes infections associated with implants or prosthetic devices
Define superficial incisional SSI
Occurs within 30 days postoperatively and involves skin to SC tissue of the incision
and at last of the following:
1) Prulent drainage
2) organisms isolated from an aseptically obtained culture of fluid
3) at least one of the following signs or symptoms:
- tenderness
- pain
- localised swelling
- redness or heat
and the culture is culture-positive
4) diagnosis of superficial incisional SSI by the surgeon or attending physician
Define deep incisional SSI
Occurs within 30 days after the operative procedure if no implant is left in place or within one year if implant is in place and the infection appears to be related to the operative procedure - involves deep soft tissue of the incision
and patient has at leats 1 of the following:
1) purulent drainage from the incision
2) deep incision spontaneously dehisces or is deliberately opened by a surgeon and is culture-positive or not cultured and the patient has at least one of the following signs or symptoms, fever (over 38 degrees) or localised pain or tenderness (a culture-negative finding)
3) an abscess or other evidence of infection involving the deep incision is found on direct examination, during reoperation or by histopathologic or radiologic examination
4)diagnosis of deep incisional SSI by a surgeon or attending physician
Define organ/space SSI
involves any part of the body
infection occurs within 30 days after the operative procedure if no implant is in place or within 1 year if implant is in place and the infection appears to be related to the operative procedure
2. Infection involves any part of the body, excluding the skin incision, fascia or muscle layers that is opened or manipulated during the operative procedure
3. The patient has at least one of the following:
A) Purulent drainage from a drain that is placed through a stab wound into the organ/space
B) Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space
C) An abscess or other evidence on infection involving them organ/space that is found on direct examination, during reoperation or by histopathologic or radiologic examination
D) Diagnosis of an organ/space SSI by a surgeon or attending physician
How can SSI be mitigated?
- Theatre airflow and workflow
- Skin prep
- Bowel prep
- Implants/foreign materials containing antimicrobials
- Screening for multi-resistant carriage (e.g. MRSA)
ANTIBIOTIC PROPHYLAXSIS
Define surgical prophylaxis
use of antibiotics pre, during our post after a diagnostic, therapeutic or surgical procedure to prevent infectious complications
What are the benefits of antibiotic prophylaxis?
patients risk of SSI decreases
severity of sequences of SSI
effectiveness of prophylaxis for that operation
What are the risks of antibiotic prophylaxis?
Allergy/anaphylaxis
antibiotic associated diarrhoea
c.diff infection
antibiotic resistance
What the common risk factors for SSI with the patient?
age
poor nutritional status
obese
smoking
diabetes mellitus
pre existing medical conditions
bacterial colonisation
immunsuppression
prolonged postoperative stay
What are the common risk factors for SSI with the operation involved?
length of surgical scrub
skin antiseptics
preoperative shaving
preoperative skin preparation
length of operation
antimicrobial prophylaxis
operating theatre ventilation
inadequate instrument sterilisation
foreign material in surgical site
surgical drains
surgical technique including haemostasis, poor closure, tissue trauma
postoperative hyperthermia
Define clean contamination
Operations in which on inflammation is encountered and the respiratory alimentary or genitourinary tracts are not entered
No break-in aseptic operating theatre technique
Define clean-contaminated
Operations in which the respiratory, alimentary or GU tract are entered but without significant spillage
Define contaminated contamination
Operations where acute inflammation is encountered, or where there is visible contamination of the wound
Examples include gross spillage from a hollow viscous during the operation or compound/ open injuries operated within four hours
Define dirty contamination
Operations in the presence of pus, where there is a previously perforated hollow viscus, or compound/ open injuries more than 4 hours old
