Perioperative Antibiotics And Surgical Site Infections

Question 1

Inflammation

Answer 1

Immune response to infection that causes heat, swelling, redness, pain or loss of function

Question 2

___ infections can be classified as incisional or organ space

Answer 2

Surgical site

Question 3

What is the overall risk for SSI for all NRC classifications?

Answer 3

5% risk for all classifications

Clean: 2-4%
CC: 3-5%
Contaminated: 4-12%
Dirty: 7-18%

Question 4

What are some risk factors in surgery?

Answer 4

Duration of surgery can double the risk of infection for every extra hour spent in surgery. Adding an hour to anesthesia and adding a person to the OR increases the risk by 30%. Propofol sitting out at room temp also increases risk since it’s lipid based and a good medium for bacterial growth.

Question 5

Aseptic technique

Answer 5

A collection of medical practices procedures that helps protect patients from potential infection

Question 6

__ is the go to antibiotics for surgery while __ and __ are also used regularly. The __ of the antibiotics determines when you give the second dose of perioperative prophylaxis

Answer 6

Cefazolin is the go to antibiotics for surgery while Ampicillin and cefoxitin are also used regularly. The half life of the antibiotics determines when you give the second dose of perioperative prophylaxis

Question 7

What percent of resident flora remain after aseptic technique?

Answer 7

20%

Question 8

In what 2 scenarios should post operative antibiotics be used?

Answer 8

Sepsis and dirty surgery OR some orthopedic surgeries have disastrous consequences so you should give post operative antibiotics

Question 9

T/F: post operative antibiotics are a common prophylactic treatment for a patient with an infection

Answer 9

F, this describes therapeutic use of antibiotics. If you’re giving post operative antibiotics then you’re treating sepsis or a dirty sx which would be therapeutic treatment

Question 10

T/F: antibiotics preferentially target pathogenic bacteria

Answer 10

F

Question 11

Therapeutic antibiotic protocol

Answer 11

Give a full course until sometime after infection looks resolved

Question 12

Prophylactic antibiotic protocol

Answer 12

Start 30-50 minutes before incision and stop within 24 hours of surgery

Question 13

CLEAN wound

Answer 13

Surgical wound
Aseptic conditions
Non- traumatic
Non- inflamed
No luminal structures entered

Question 14

CONTAMINATED Wound

Answer 14

• Any traumatic wound
• Surgical wound with gross spillage of contaminating contents
• Surgical wound with major break in asepsis

Question 15

CLEAN CONTAMINATED wound

Answer 15

Surgical wound where luminal structure is entered in a controlled manner, otherwise clean with drain

Question 16

DIRTY wound

Answer 16

Infection, abscess, purulent discharge, necrotic tissue

Question 17

What are some ways to reduce SSI’s other than antibiotics?

Answer 17

Practicing aseptic technique and following halsteads principles. For clean contaminated surgeries you should perform the clean procedures first and then have a plan for entering luminal organs. Isolate the organ, take it out of the abdomen and pack it off with lap sponges. Then use separate instruments for different levels of contamination and have your suction ready. After closing the organ, you can lessen contamination buy changing gloves and instruments and lavage the organ/abdomen

Question 18

How long after surgery is infection considered a surgical site infection?

Answer 18

30 days

Question 19

In what procedures are prophylactic antibiotics indicated?

Answer 19

Clean contaminated, contaminated and dirty

Question 20

Halsteads Principles

Answer 20

1. Aseptic technique
2. Gentle tissue handling
3. Control hemorrhage
4. Eliminate dead space
5. Accurate apposition of tissue with minimal tension
6. Preservation of blood supply

Question 21

What defines infection?

Answer 21

Presence of both tissue inflammation and 10(5) bacterial organisms present per gram