Perioperative Antibiotics/Surgical Site Infections Flashcards
What 4 things need to occur before an infection develops?
- Bacteria recognize the tissue
- Bacteria invade the tissue
- Bacteria proliferate within tissue
- Tissue becomes inflamed
T/F: infection means that there are bacteria present on the surface of the tissue
False! This is contamination
Name some of the factors required to classify a surgical site as being infected according to the CDC?
- Purulent drainage
- Bacteria aseptically cultured
- Heat, redness, pain, or localized swelling with a reopened incision
- Doctor diagnoses SSI–> treat empirically
Is it possible to avoid contamination during a surgery?
NO- contamination will happen as you cannot sterilize the air, the goal is to avoid infection
What is the risk of infection in an uncomplicated clean surgery?
2.5-4.8%
Is it ever ok to give antibiotics to every patient undergoing surgery?
NO- this is how resistance occurs. need to target the patients at higher risk
Name some of the common risk factors for SSIs?
- Prolonged surgery time and anesthesia time
- NRC Classification of clean contaminated, contaminated, or dirty
- clipping before induction
- Endocrinopathies (hyperadrenocorticism and hypothyroidism)
- Obesity
- High numbers of people in operating room
- Propofol induction
- Foreign material/implants
- Intact males
When should skin be clipped to avoid SSI risk?
After induction
What two endocrinopathies predispose to SSIs
Cushings and Hypothyroidism
What are the two most important things you can do to prevent SSIs?
Maintaining aseptic technique and maintaining healthy tissues
What are some of the reasons that you cant count on antibiotics to prevent SSIs?
Antibiotics dont kill all bacteria, they kill “good” resident bacteria, and they cant kill bacteria in certain areas
Name three areas that antibiotics cant reach
Devitalized tissue, fluid pockets, and biofilm
Name all 6 of Halsed’s principles
- Gentle tissue handling
- Meticulous control of hemorrhage
- Strict aseptic technique
- Preserve blood supply to tissues
- Eliminate dead space
- Appose tissues accurately with minimal tension
Define prophylactic antibiotics.
Antibiotics given only during surgery to prevent infection
Define Therapeutic antibiotics.
A full course of antibiotics given to treat infection.
When are prophylactic antibiotics indicated?
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)
What are the 3 principles of prophylactic antibiotics?
- Target expected bacteria
- Ensure peak tissue concentration at the time of incision and throughout the period of contamination
- Discontinue within 24 hours of surgery
What is the first line antibiotic recommended for prophylaxis?
Cefazolin
T/F: It is okay to give postoperative antibiotics to prevent infection in a routine surgery
False- they are never indicated
What are two exceptions to the rule about never giving post op antibiotics for prophylaxis?
- 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)
When are post-op antibiotics indicated?
When there is an infection present in the patient (ex-pyometra)
