surgical site infection prevention Flashcards
classification of SSIs
superficial: skin and subQ tissue
deep: Deep soft tissue (fascia and muscle)
organ/space: organ/space
prehospital interventions
smoking cessation, MRSA screening and decolonization, bowel prep
smoking and SSIs
smokers have the highest risk for SSIs
smoking results in: vasoconstriction of vessels in the surgical bed, tissue hypovolemia and hypoxia, decreased transportation of nutrients, altered immune response
smoking cessation: includes tobacco, marijuana and e-cigarettes, must stop completely for a minimum of 4-6 weeks before surgery, decreases surgical site infections and other complications, nictotine replacement therapy is endorsed
MRSA screening and decolonization
recommended for: total joint replacement and cardiac procedures**
screen for MRSA and IF positive**:
-decolonization - no standard protocol (i.e. mupirocin and chlorhexidine)
-must be completed close to the day of surgery
-compliance is key
bowel preparation
recommended for: elective colorectal surgeries
lowers rates of : SSIs, anastomotic leaks, C. diff and post op illues, LOS and readmission rates
combination* of mechanical bowel prep plus* neomycin 1 g + metronidazole 1 g PO at 1 pm, 2 pm and 10 pm the day before surgery; if allergic to metronidazole use erythromycin 1 g + neomycin 1 g at the above times
must be completed day before surgery**
compliance is key: must use both** otherwise no benefit
glucose control
short term perioperative glucose control with insulin:
- all surgical patients regardless of diabetic status
- lowers risk for SSIs
- cardiac patient goal under 180
- all other patients 110-150
patients who benefit from antibiotic prophylaxis
procedures with a high rate of infection
procedures with a low incidence but severe consequences if an infection occurs
balance cost of treating and morbidity of an infection vs cost and morbidity of using prophylaxis
antimicrobial selection overview
base on antimicrobial stewardship policies**
active against most likely pathogens
use most narrow spectrum agent
maintains adequate serum and tissue concentrations during the procedure
safe
administered for the shortest period of time
when to use cefazolin for surgical prophylaxis
billiary tract, cardiac, gastroduodenal, head and heck (w placement of prosthesis), neurosurgery, OB-GYN, ortho, small intestine (non-obstructed), thoracic, urologic, vascular
when to use cefazolin + metronidazole for surgical prophylaxis**
appendectomy, colorectal, head and neck (cancer surgery), small intestine (obstructed)
when to use vancomycin for surgical prophylaxis
B-lactam allergy AND
cardia, neuro, ortho, thoracic, vascular
when to use clindamycin + gentamicin for surgical prophylaxis
B-lactam allergy AND
appendectomy, billiary tract, colorectal, gastroduodenal, OBGYN, small intestine
when to use vancomycin + getnamicin for surgical prophylaxis
B lactam allergy AND gastroduodenal PEG placement or revistion
when to use clindamycin for surgical prophylaxis
B-lactam allergy AND
head and neck
when to use metronidazole + gentamicin for surgical prophylaxis
B-lactam allergy AND small intestine (obstructed)
