Term
|
Definition
¡ Administration of antibiotic with in patients
with no signs of infection to reduce the
risk of post-operative wound infection
¡ Should be given PRIOR to procedures
where the risk
¡ Cover the predominant flora of operative
site |
|
|
Term
|
Definition
Occur within 30 days of surgery
¡ Definition
§ Incisional (i.e cellulitis)
▪ Superficial
▪ Deep § Organ/space
▪ Can involve any anatomic area other than the incision site
▪ Patient who develops bacterial peritonitis after bowel surgery
¡ If prosthetic implant involved, a deep incisional or organ space SSI can be reported up to a year (Staph a. or staph coag -) |
|
|
Term
| Antibiotic Prophylaxis issues |
|
Definition
¡ Effectives of antibiotics most dependent upon having tissue levels of the antibiotic at time of initial skin incision
¡ Prolonged surgery – antibiotics may need to be re-dosed
¡ No convincing data to document efficacy for post operative administration |
|
|
Term
|
Definition
¡ Includes activity against suspected
pathogens
¡ Does not induce bacterial resistance
¡ Effective tissue penetration
¡ Minimal toxicity
¡ Minimal side effects
¡ Long half life
¡ Cost effective |
|
|
Term
|
Definition
§ Antibiotics administered before contamination of previously sterile tissues or fluids
§ Goal: prevent a surgical site infection (SSI) from developing |
|
|
Term
|
Definition
¡ Clean (SSI risk < 2%)
¡ Clean-contaminated (SSI risk 2 - 10%)
¡ Contaminated (SSI risk 10-20%)
¡ Dirty (SSI risk > 30%)
¡ Wound classification can be influenced by surgical findings (i.e. gangrenous gallbladder) |
|
|
Term
|
Definition
¡ Antimicrobial prophylaxis NOT routinely
recommended
¡ Exceptions include operations that can
have a negative outcome
§ i.e. Craniotomy, cardiac surgery, or prosthetic
device implantation
¡ Elective, not emergency, nontraumatic
¡ Primary closed
¡ No acute inflammation
¡ Not involving respiratory, GI, biliary, and
GU tracts
¡ i.e. Most plastic and dermatologic surgery |
|
|
Term
| Clean Contaminated Procedures |
|
Definition
¡ Urgent or emergency case that is
otherwise clean
¡ Elective opening of respiratory, GI, biliary
or GU tract with MINIMAL spillage
¡ i.e. Invasive head and neck surgery,
hysterectomy |
|
|
Term
|
Definition
¡ Nonpurulent inflammation
¡ Gross spillage of GI tract
¡ Entry into biliary or GU tract in the presence of infected bile or urine
¡ Major break in technique
¡ Penetrating trauma < 4 hours old
¡ Chronic open wounds to be grafted or
covered
¡ i.e. Colorectal surgery |
|
|
Term
|
Definition
¡ Purulent inflammation (i.e. abscess)
¡ Preoperative perforation of respiratory, GI, biliary, or GU tract
¡ Penetrating trauma > 4 hours old
¡ i.e. Perforated appendicitis with abscess formation
Antibiotics are utilized for treatment and not prophylaxis |
|
|
Term
| Increased risk of infection |
|
Definition
¡ Age
¡ Nutritional status
¡ Diabetes
¡ Smoking
¡ Obesity
¡ Coexisting infection at distal body sites
¡ Colonization with resistant
microorganisms
¡ Altered immune response
¡ Length of pre-operative stay
¡ Duration of surgical scrub
¡ Preoperative skin preparation
¡ Preoperative shaving
¡ Duration of operation
¡ Antimicrobial prophylaxis
¡ Operating room ventilation
¡ Sterilization of instruments
¡ Implantation of prosthetic materials
¡ Surgical drains
¡ Surgical technique |
|
|
Term
|
Definition
¡ Appropriate timing
§ Relation to incision time
§ Repeated dosing based upon on length of
procedure and antibiotic half life
¡ Appropriate selection
¡ Appropriate duration |
|
|
Term
|
Definition
¡ Nose
§ S. aureus, pneumococcus, meningococcus
¡ Skin
§ S. aureus, S. epidermidis
¡ Mouth/pharynx
§ Streptococci, pneumococcus, e. coli,
bacteroides, fusobacterium,
peptostreptococcus
¡ Urinary tract
§ E. coli, proteus, klebsiella, enterobacter
¡ Colon
§ E. coli, klebsiella, enterobacter, bacteroides
spp, clostridia,
¡ Biliary tract
§ E. coli, klebsiella, proteus, clostridia, enterobacter
¡ Vagina
§ Streptococci, staphylococci, E. coli,
peptostreptococci, bacteroides species
¡ Upper respiratory tract
§ Pneumococcus, H. influenzae |
|
|
Term
|
Definition
¡ Cefazolin is the most common agent
utilized when skin flora is the source of contamination
§ 1 gram in patients who are < 80 kg
§ 2 grams in patients who are ≥ 80 kg
¡ Clean procedures |
|
|
Term
| Administration of antibiotic |
|
Definition
¡ Pre-operative antibiotic
§ Given within 60 minutes before initial surgical incision
§ Exception: Vancomycin and the
fluoroquinolones should be given within 60 – 120 minutes
▪ Prolonged infusion time with these antibiotics
¡ Cefazolin, other cephalosporins, and
ampicillin-sulbactam can be given IV or IV push over 3-5 minutes |
|
|
Term
|
Definition
¡ Dose Optimize
§ Preoperative dose is IMPORTANT
¡ Adjust antimicrobial prophylaxis dose for obese patients (body mass index >30)
¡ Obesity linked to increased risk for SSI |
|
|
Term
|
Definition
¡ Duration should be less than 24 hours for most procedures
¡ Exception: Cardiac
§ 48 hours |
|
|
Term
| Antimicrobial Prophylaxis |
|
Definition
| ¡ Should be directed against the most likely infecting organisms but it does not need to eradicate every potential pathogen to be effective |
|
|
Term
| Principle of antimicrobial prophylaxis |
|
Definition
Preop administration, serum levels adequate throughout procedure with a drug active against expected microorganisms
High Serum Levels
Preop timing
IV route
Highest dose of drug
During Procedure
Long half-life
Long procedure–redose
Large blood loss–redose
Duration
None after wound closed
24 hours maximum |
|
|
Term
| Nasal screening and decolonization |
|
Definition
¡ Colonization of nares with S. aureus =
risk factor
¡ Intranasal application of mupirocin
ointment may reduce the rate of nasal
carriage of S. aureus
¡ Chlorhexidine (CHG) may also benefit |
|
|
Term
| Peri-operative Antibiotic re-dosing |
|
Definition
¡ Re-dose with 2 half lives in normal renal function
¡ Underlying disease states may affect
antibiotic metabolism
§ Thermal burn and spinal cord injuries -> Increased clearance
§ Cardiac à Increased Vd and decrease
clearance |
|
|
Term
|
Definition
¡ Surgical Care Improvement
¡ Formerly known as Surgical Improvement
Project (SIP)
¡ Began in 2002
¡ CMS and Joint Commission
§ Financial reimbursement
§ Value based purchasing |
|
|
Term
|
Definition
¡ Cardiac/CABG
¡ Colorectal
¡ Hip/Knee Arthroplasty
¡ Hysterectomy
¡ Vascular |
|
|
Term
SCIP Measures - Appropriate antibiotic
choice |
|
Definition
Number of patients who received the appropriate prophylactic antibiotic
over
All patients for whom prophylactic antibiotics are indicated |
|
|
Term
SCIP Measures - Appropriate timing of
prophylactic antibiotics |
|
Definition
Number of patients who received the prophylactic antibiotic within 1hr prior to incision (2hr: Vancomycin or Fluoroquinolones)
over
All patients for whom prophylactic antibiotics are indicated |
|
|
Term
| SCIP Measures - Appropriate discontinuation of antibiotics |
|
Definition
Number of patients who received prophylactic antibiotics and had them discontinued in 24 h (48h cardiac)
over
All patients who received prophylactic antibiotics |
|
|
Term
|
Definition
¡ Temperature
¡ Glucose
¡ Hair removal
¡ Catheter
¡ VTE prophylaxis |
|
|
Term
| Healthcare associated infections |
|
Definition
¡ No reimbursement for hospital acquired
infections
§ CLABSI
§ CAUTI |
|
|
Term
|
Definition
¡ Common pathogens:
§ S. aureus, S.epidermidis
¡ Recommended Antimicrobial
§ Cefazolin1-2 g, Cefuroxime 1.5 g
§ Vancomycin 10-15 mg/kg |
|
|
Term
|
Definition
¡ Esophageal, gastroduodenal surgery
¡ Common pathogens
§ Enteric gram negative bacilli, gram positive
cocci
¡ Recommended Antimicrobial
§ Cefazolin |
|
|
Term
|
Definition
¡ Common pathogens
§ Enteric gram negative bacilli, enterococci, anaerobes
¡ Recommended Antimicrobial
§ Cefazolin + Metronidazole
§ Cefoxitin
§ Ciprofloxacin + Metronidazole |
|
|
Term
|
Definition
¡ Common pathogens
§ S. aureus, S. epidermidis
¡ Recommended Antimicrobial
§ Cefazolin
§ Vancomycin
§ Clindamycin |
|
|
Term
|
Definition
¡ Vaginal, abdominal, or laparoscopic
hysterectomy
¡ Common pathogens
§ Enteric gram negative bacilli, anaerobes,
Group B Strep, Enterococci
¡ Antimicrobial agent
§ Cefazolin, Cefoxitin |
|
|
Term
|
Definition
¡ Consider use in high suspicion of MRSA
¡ Life threatening allergy to penicillins and cephalosporins
¡ Justification needed for SCIP |
|
|
Term
|
Definition
| ¡ Colonization with antibiotic resistant hospital flora during surgery may lead to an SSI |
|
|
Term
| Drains and Intravascular Devices |
|
Definition
¡ NO evidence to support need for
continuing antibiotic prophylaxis while
drains and devices are in place |
|
|
Term
|
Definition
¡ Correct antibiotic
§ Allergy clarification
§ Minimize antimicrobial resistance
¡ Dose optimization
¡ Duration
§ Automatic stop |
|
|
