Perioperative Antibiotics/Surgical Site Infections

Question 1

What 4 things need to occur before an infection develops?

Answer 1

1. Bacteria recognize the tissue
2. Bacteria invade the tissue
3. Bacteria proliferate within tissue
4. Tissue becomes inflamed

Question 1

T/F: infection means that there are bacteria present on the surface of the tissue

Answer 1

False! This is contamination

Question 2

Name some of the factors required to classify a surgical site as being infected according to the CDC?

Answer 2

1. Purulent drainage
2. Bacteria aseptically cultured
3. Heat, redness, pain, or localized swelling with a reopened incision
4. Doctor diagnoses SSI–> treat empirically

Question 3

Is it possible to avoid contamination during a surgery?

Answer 3

NO- contamination will happen as you cannot sterilize the air, the goal is to avoid infection

Question 4

What is the risk of infection in an uncomplicated clean surgery?

Answer 4

2.5-4.8%

Question 5

Is it ever ok to give antibiotics to every patient undergoing surgery?

Answer 5

NO- this is how resistance occurs. need to target the patients at higher risk

Question 6

Name some of the common risk factors for SSIs?

Answer 6

1. Prolonged surgery time and anesthesia time
2. NRC Classification of clean contaminated, contaminated, or dirty
3. clipping before induction
4. Endocrinopathies (hyperadrenocorticism and hypothyroidism)
5. Obesity
6. High numbers of people in operating room
7. Propofol induction
8. Foreign material/implants
9. Intact males

Question 7

When should skin be clipped to avoid SSI risk?

Answer 7

After induction

Question 8

What two endocrinopathies predispose to SSIs

Answer 8

Cushings and Hypothyroidism

Question 9

What are the two most important things you can do to prevent SSIs?

Answer 9

Maintaining aseptic technique and maintaining healthy tissues

Question 10

What are some of the reasons that you cant count on antibiotics to prevent SSIs?

Answer 10

Antibiotics dont kill all bacteria, they kill “good” resident bacteria, and they cant kill bacteria in certain areas

Question 11

Name three areas that antibiotics cant reach

Answer 11

Devitalized tissue, fluid pockets, and biofilm

Question 12

Name all 6 of Halsed’s principles

Answer 12

1. Gentle tissue handling
2. Meticulous control of hemorrhage
3. Strict aseptic technique
4. Preserve blood supply to tissues
5. Eliminate dead space
6. Appose tissues accurately with minimal tension

Question 13

Define prophylactic antibiotics.

Answer 13

Antibiotics given only during surgery to prevent infection

Question 14

Define Therapeutic antibiotics.

Answer 14

A full course of antibiotics given to treat infection.

Question 15

When are prophylactic antibiotics indicated?

Answer 15

When the NRC classification is clean contaminated or worse and/or there are other risk factors present OR if the consequences of infection would be disastrous (permanent implant)

Question 16

What are the 3 principles of prophylactic antibiotics?

Answer 16

1. Target expected bacteria
2. Ensure peak tissue concentration at the time of incision and throughout the period of contamination
3. Discontinue within 24 hours of surgery

Question 17

What is the first line antibiotic recommended for prophylaxis?

Answer 17

Cefazolin

Question 18

T/F: It is okay to give postoperative antibiotics to prevent infection in a routine surgery

Answer 18

False- they are never indicated

Question 19

What are two exceptions to the rule about never giving post op antibiotics for prophylaxis?

Answer 19

• some implants may indicate this as risks are high, or if there is devitalized tissue or dead space that you cannot eliminate (gives time for tissue health to return before stopping the antibiotics)

Question 20

When are post-op antibiotics indicated?

Answer 20

When there is an infection present in the patient (ex-pyometra)