Surgical use of Antimicrobials

Question 1

What is a clean wound? (examples etc.)

Answer 1

Non-traumatic wound, elective surgery with primary intention healing, no inflammation, no break in aseptic technique, resp, alimentary and urogenital not enetered.

Question 2

Are prophylactic antimicrobials indicated in clean surgery?

Answer 2

Usually not indicated.

Question 3

Under what circumstances would you give prophylactic antimicrobials in clean surgery?

Answer 3

Surgery longer than 90 mins, implant placement, infection would be catastrophic, immunocompromised.

Question 4

What is a clean-contaminated wound? (examples etc.)

Answer 4

GIT or resp entered without spillage, urogenitall entered with no infection, biliary tract entered with no infection, minor break in aseptic technique.

Question 5

Are prophylactic antimicrobials indicated in clean-contaminated surgery?

Answer 5

Indicated but controversial - case by case basis.

Question 6

What is a contaminated wound? (examples etc.)

Answer 6

Gross spillage from GIT, entry to urogenital/biliary with infection, fresh traumatic wound <4 hours, major break in aseptic technique.

Question 7

Are prophylactic antimicrobials indicated in contaminated surgery?

Answer 7

Yes

Question 8

What is a dirty wound? (examples etc.)

Answer 8

Perforated viscous encountered, acute bacterial inflammation with or without pus, traumatic wound >4 hours, transection of clean tissue to gain access to pus.

Question 9

Are prophylactic antimicrobials indicated in dirty surgery?

Answer 9

No, but therpeutic antimicrobials are.

Question 10

How is antimicrobial prophylaxis achieved?

Answer 10

Aim to achieve and maintain MIC of antimicrobial agent at surgical site throughout procedure. Given I.V. 30-60 minutes before incision, additional doses at 1-2 half lives.

Question 11

Is giving antimicrobials 3-6 hours after surgery useful?

Answer 11

No, it does not reduce wound infection.