Term
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Definition
introduced antiseptic prophylaxis into medicine;
during the 1840's:
- determined puerperal fever was septic & contagious (higher rate of infant mortality from birth in hospitals than at home);
- ordered all students to wash their hands with chlorinated lime before examining pts --> cut death rate;
1850-1865:
- research & ideas met with great resistance from medical community
- fired from hospital job;
- died from an infection he had contracted during a surgery performed in 1865 after a mental breakdown; |
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Term
| Superficial Incisional Surgical Site Infection |
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Definition
| involves only the skin & subcutaneous tissue |
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Term
| Deep Incisional Surgical Site Infection |
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Definition
| involves the deeper soft tissues of the incision --> fat & muscle fascia |
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Term
| Organ/space Surgical Site Infection |
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Definition
| involves any part of the anatomy other than the incised body wall layers |
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Term
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Definition
| prevention of contamination of previously sterile tissue by the administration of antibiotics |
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Term
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Definition
| most common complication of surgery |
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Term
| Top 5 Most Common Pathogens of SSIs |
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Definition
1) Staphylococcus aureus;
2) Coag. Neg. Staphylococci;
3) Enterococcus spp.;
4) Escherichia coli;
5) Pseudomonas aeruginosa |
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Term
| Patient-Related Risk Factors for SSIs |
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Definition
extremes of age (young & elderly);
poor nutritional status;
DM, smoking, steroid use, obesity;
coexistent infections at a remote site;
colonization with microorganisms;
altered immune response;
length of preoperative stay; |
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Term
| Operation-Related Risk Factors for SSIs |
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Definition
duration of surgical scrub;
skin antisepsis;
preoperative shaving & skin prep;
duration of operation;
antimicrobial prophylaxis;
operating room ventilation;
inadequate sterilization of instruments;
foreign material; |
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Term
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Definition
Prophylaxis IS INDICATED for this type of wound;
an uninfected operative wound in which no inflammation is encountered & respiratory, alimentary, genital, or uninfected urinary tract is NOT entered;
in addition, clean wounds are primarily closed &, if necessary, drained with closed drainage;
operative incisional wounds that follow non-penetrating (blunt) trauma should be included in this category if they meet criteria |
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Term
| Class II/Clean-Contaminated |
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Definition
Prophylaxis IS INDICATED for this type of wound;
An operative wound in which the respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions & without unusual contamination;
Specifically, operations involving the biliary tract, appendix, vagina, & oropharynx are included in this category, provided no evidence of infection or major break in technique is encountered; |
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Term
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Definition
Requires Antibiotic TREATMENT, NOT PROPHYLAXIS;
Open, fresh, accidental wounds; In addition, operations with major breaks in sterile technique (e.g. open cardiac massage) or gross spillage from the GI tract, & incisions in which acute, nonpurulent inflammation is encountered are included in this category; |
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Term
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Definition
Requires TREATMENT, NOT PROPHYLAXIS!!!
Old traumatic wounds with retained devitalized tissue & those that involve existing clinical infection or perforated viscera; Suggests taht the organisms causing postoperative infection were present in the operative field before the operation; |
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Term
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Definition
- should be safe, cost-effective, & bactericidal;
- should cover the likely organism present at the surgical site;
- avoid unnecessary broad spectrum drugs; |
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Term
| Antibiotic Administration |
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Definition
| Administer from 0 to 1 hr prior to 1st incision (2 hrs for vancomycin) to obtain bactericidal concentrations |
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Term
| Goals of Surgical Prophylaxis |
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Definition
prevent postoperative infection of surgical site;
prevent postoperative infectious morbidity & mortality;
reduce the duration & cost of health care;
have no adverse consequences for the microbial flora of the patient or the hospital; |
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Term
| Non-pharm Methods for Preventing SSIs |
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Definition
clippers should be used to remove hair on the MORNING OF procedure;
Glycemic control;
Maintaining normothermia;
Surgical scrubs;
OR air exchanges;
Limiting in & out traffic;
Proper preparation of surgical field;
No wounds on surgeon's hands; |
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Term
| Gastroduodenal Surgery Prophylaxis |
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Definition
Bacteria:
- enteric Gram-Neg bacilli, Gram-Pos cocci, oral anaerobes;
ABX:
- cefazolin 1 g IV x 1 at induction;
- PCN allergy: ciprofloxacin;
Indicated ONLY in HIGH RISK pts:
- obstruction, hemorrhage, decreased gastric motility, malignancy, acid suppression therapy, morbid obesity; |
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Term
| Hepatobiliary Surgery Prophylaxis |
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Definition
Bacteria:
- enteric Gram-Neg bacilli, Enterococci, Clostridia;
NOT INDICATED for laparascopic procedures;
INDICATED for HIGH RISK pts only:
- cholecystitis, common duct stones, previous biliary surgery, age > 70 years, jaundice, obesity, DM;
ABX:
- cefazolin 1 g IV x 1 at induction
- PCN allergy: Ciprofloxacin |
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Term
| Colorectal Surgery Prophylaxis |
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Definition
Bacteria:
- Enteric Gram-Neg bacillis, Enterococci, & Anaerobes;
ABX:
- cefoxitin, cefotetan, or cefazolin
PLUS metronidazole;
OR
ampicillin/sulbactam
OR
ertapenem;
PCN Allergy:
- gentamicn + metronidazole
- clindamycin + aztreonam
- clindamycin + aminoglycoside
- clindamycin + fluoroquinolone
Alternative:
- PO neomycin + erythromycin
- PO neomycin + metronidazole |
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Term
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Definition
Bacteria:
- Enteric Gram-Neg bacilli, Enterococci, & Anaerobes;
ABX:
- cefoxitin, cefotetan, OR cefazolin
PLUS metronidazole;
PCN Allergy:
- gentamicin + metronidazole |
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Term
| Urologic Procedures Prophylaxis |
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Definition
Bacteria:
- Enteric Gram-Neg bacilli & Enterococci;
ABX:
- cefazolin;
- TMP/SMX;
PCN Allergy:
- ciprofloxacin |
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Term
| Caesarean Section Prophylaxis |
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Definition
Bacteria:
- Enteric Gram-Neg bacilli, Anaerobes, Grp B Streptococci, & Enterococci;
ABX Recommendations:
- cefazolin after cord is clamped;
PCN Allergy:
- metronidazole |
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Term
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Definition
Bacteria:
- Enteric Gram-Neg bacilli, Anaerobes, Grp B Streptococci, Enterococci;
ABX Recommendations:
- Vaginal --> cefazolin
- Abdominal --> cefazolin, cefoxitin, cefotetan, ampicillin/sulbactam, OR cefuroxime;
Abdominal w/ PCN Allergy:
- clindamycin + AMG
- clindamycin + FQN
- clindamycin + aztreonam
- metronidazole + AMG
- metronidazole + FQN |
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Term
| Head & Neck Surgery Prophylaxis |
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Definition
Bacteria:
- Staphylococcus aureus, Streptococci, Enterococci;
ABX:
- cefazolin
Alternative:
- clindamycin
PCN Allergy:
- vancomycin |
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Term
| Cardiothoracic Surgery Prophylaxis |
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Definition
Bacteria:
- Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium, Enteric Gram-Neg bacilli;
ABX:
- cefazolin
- cefuroxime
PCN Allergy:
- vancomycin
- clindamycin |
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Term
| Vascular Surgery Prophylaxis |
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Definition
Bacteria:
- Staphylococcus aureus, Staphylococcus epidermidis, Enteric Gram-Neg bacilli;
ABX:
- cefazolin or cefuroxime
PCN Allergy:
- vancomycin OR clindamycin |
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Term
| Orthopedic Surgery Prophylaxis |
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Definition
Bacteria:
- Staphylococcus aureus, Staphylococcus epidermidis;
ABX:
- Clean: NONE required
- Joint Replacement: cefazolin
- Hip Fracture: cefazolin
PCN Allergy:
- vancomycin OR clindamycin |
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Term
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Definition
Bacteria:
- Staphylococcus aureus, Staphylococcus epidermidis;
ABX:
- CSF Shunt: cefazolin OR ceftriaxone
- Craniotomy: cefazolin OR cefotaxime, OR TMP/SMX
PCN Allergy:
- vancomycin |
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