IC11 - Surgical prophylaxis Flashcards
Define surgical site infections (SSIs)
Infections occurring within 30 days after surgical operation or within 1 year if an implant was left in place and affecting the incision or deep tissue at the operation site.
Considerations in selection of SAP regimen, including choice of antibiotic, timing of administration, antibiotic dosing and redosing and duration.
- effective against the pathogens most likely to contaminate the surgical site, generally skin flora
- given in an appropriate dose and at a time that achieves highest tissue concentration upon skin incision,
- safe, and
- administered for the shortest effective period to minimise adverse effects, development of antimicrobial resistance, and costs.
List non-antimicrobial strategies recommended to reduce the risk of SSIs.
- Do not remove hair at the operative site unless the presence of hair will interfere with the operation. Do not use razors.
* If hair removal is necessary, remove hair outside the operating room using clippers or a depilatory agent. - Control blood glucose during the immediate postoperative period - postoperative blood glucose ≤ 180 mg/dL (10 mmol/L).
- Maintain normothermia (temperature ≥ 35.5°C) during the perioperative period.
- Optimize tissue oxygenation by administering supplemental oxygen during and immediately following surgical procedures involving mechanical ventilation.
- Use alcohol-containing preoperative skin preparatory agents if no contraindication exists.
- Use impervious plastic wound protectors for GI and biliary tract surgery.
- Use a checklist based on WHO checklist to ensure compliance with best practices to improve surgical patient safety.
- Perform surveillance for SSIs.
- Provide ongoing feedback of SSI rates to surgical and perioperative personnel and leadership.
Is SSI considered a healthcare-associated infection?
Yes.
What is SAP indicated for?
- Clean surgery where prosthesis or implant will be inserted or when SSI would pose catastrophic risk
- Clean-contaminated surgery
- Contaminated (antibiotic used as treatment, not SAP)
Note: Antimicrobial prophylaxis may be justified for any procedure if the patient has an underlying medical condition a/w increased risk of SSI or if patient is immunocompromised (eg malnourished, neutropenic, receiving immunosuppressant)
Which type of surgery warrants a treatment of infx instead of SAP?
Contaminated surgery
Drugs with risk of CDAD development
3rd gen cephalosporins, FQ, clindamycin
When is vancomycin prophylaxis considered?
for patients with known MRSA colonisation or recent MRSA infection
When should we screen for MRSA colonization prior to surgery?
for patients who will be undergoing high-risk surgeries (cardiac, orthopaedic and neurosurgery with implant)
Why is cefazolin added to vancomycin for prophylaxis in MRSA colonised patients?
Vancomycin is less effective than cefazolin for preventing SSI caused by methicillin-susceptible Staphylococcus aureus (MSSA)
Is maculopapular rash considered a severe penicillin allergy?
No. It is an uncomplicated non-IgE-mediated allergic reaction to penicillin.
Alternatives for people with maculopapular rash with penicillin use.
Cephalosporins can be considered after
discussion with the patient and allergy team.
Or Cefazolin (safer due to unique R1 side chain)
Timing of SAP administration
Start administration within 30-60 min before surgical incision; the antibiotic should be infused completely prior to the incision.
FQs and vancomycin which require longer infusion time, should be administered at least 1 hour before the incision.
When is Intra-operative re-dosing required?
- duration of the procedure exceeds two-half-lives of the drug, or
- There is excessive intra-operative blood loss (i.e. > 1500mL), or
- There are extensive burns.
Examples of severe penicillin allergy
anaphylaxis, urticaria, bronchospasm and angioedema; SJS, TEN
