Surgical prophylaxis involved the use of antibiotics at the time of surgery to avoid subsequent colonization of pathogens at the surgery site, also known as surgical site infection. It is well documented that SSIs are among most primary postoperative complications, which contribute to worsening of morbidity, increased length of hospital stay, and total cost of treatment. Prevention stands well used one of the approaches that can effectively reduce incidence rates in situations with high likelihood of contamination.
Epidemiology
SSIs make up about 20% of total healthcare-associated infections globally. Centers for Disease Control and Prevention (CDC) approximate that SSIs affect 2-5 % of inpatient procedures in the United States.
Risk Factors for SSIs:
Patient-related factors: The main predisposing factors towards a higher risk of infections are diabetes, obesity, tobacco use, a weaker immune system, advanced age, and malnutrition.
Surgery-related factors:
Prolonged procedures contaminated operating procedures, operations for urgencies, and operations in which prosthetic devices are to be used.
Healthcare factors: Failure to adhere to certain infections controls measures, poor sterilization of the surgical instruments, wrong choice or time for antibiotic use leads to the high infection rates.
Anatomy
Pathophysiology
Microbial Contamination Sources: There are two routes through which microbes can be introduced during surgery; from the patient skin, the operating environment or the instruments used. This is usually caused by the bacteria that are normally found in our skin known as Staphylococcus aureus. However, gram-negative bacteria and anaerobes depending on the region of surgery may also be involved also.
Colonization and infection: The bacteria which gets into the body during surgery settles at the site of injury may attach themselves and multiply if they overcome the immune system.
The size of the inoculum, the degree of pathogenicity and the amount of oxygen present in the tissues determine whether colonization becomes an infection.
Host Immune Response Inflammatory Response: The human body has some natural barriers, including eliciting an immune response which accustoms the body to neutrophils and macrophages. Nevertheless, taking antiretroviral drugs or experiencing diabetes, obesity or any other circumstances the immune response is compromised.
Local Tissue Response: Surgery leads to tissue ischemia that means local blood supply and oxygen delivery are decreased.
Inadequate oxygen supply can also suppress immunocytes and inhibits the rate of tissue repair therefore increasing the risk of infection at the site.
Antibiotic Prophylaxis:
Timing and Selection: Systemic antibiotics are started before making the incision of the skin, such that the concentration of tissue at the time of surgery is maximized.
Selection of antibiotics: It is done according to the expected pathogens in the surgery for example cefazolin for skin flora of clean surgery. Mechanism: Using antibiotics implies the suppression of bacterial proliferation or destruction of bacteria on which the bases for infection do not develop.
They are not a sterile technique but minimize the occurrence of SSIs.
Host Factors Immune Status: Immunosuppressive therapy, malnutrition, or chronic diseases like diabetes can impair the host’s ability to fight off infection.
Age: Older individuals have a slower immune response and longer time to healing which raises the SSI risk.
Etiology
Bacterial Contamination
Endogenous sources: Some of the patient’s flora that can potentially cause infection include skin, respiratory, gastrointestinal, or genitourinary flora.
Exogenous sources: Pathogens or other contaminants from the operating room environment, from surgical instruments, or the operating surgical team.
Types of Bacteria:
Gram-positive organisms: The organisms most frequently involved are Staphylococcus aureus including methicillin-resistant S aureus; coagulase-negative staphylococci; other bacteria involved include enterococci and Streptococcus species.
Gram-negative organisms: They are practiced often in cases of gastrointestinal or genitourinary tracts including Escherichia coli or Klebsiella species.
Risk Factors for Infection Type of surgery: There is a risk which applies to all the surgeries and the contaminated as well as the dirty surgeries which are categorically different.
Patient factors: A patient characteristic or condition that increases the likelihood of infection is known as risk factor and include age, obesity, diabetes, immune state, and malnutrition.
Surgical technique: Surgical duration also plays a part in infection rates and sterilization of instruments also.
Antibiotic Resistance: Skin prophylactic use of broad-spectrum antibiotics such as cefazolin may lead to acute infection by a resistant organism such as MRSA or ESBL bacteria.
Timing of Prophylaxis: Surgical prophylaxis requires the administration of the antibiotic at a particular time before an operation (in most cases before making the first incision less than 30-60 minutes).
Genetics
Prognostic Factors
Clinical History
Age Group:
Adults: In most cases, standard protocols are used for most adult patients.
Older adults: These patients have a different pharmacokinetics and may need their dose to be adjusted or given a different prophylactic agent owing to their renal or liver disease.
Physical Examination
General assessment
Medical history
Other diagnostic tests
Age group
Associated comorbidity
Diabetes Mellitus
Obesity
Cardiovascular Disease
Immunocompromised State
Chronic Lung Disease
Associated activity
Acuity of presentation
Type of Surgery: The acuity is also based on the surgery type.
Elective procedures generally make it possible to implement good preventive measures, whereas urgent or even emergency surgical procedures may entail decisions about prophylaxis during, or immediately before, surgery.
Patient Factors:
Known medical conditions, history of infection, and general conditions like diabetes, obesity and immunosuppression can influence the decision-making process for surgical prophylaxis.
Infection Rates: It is possible that the severity of presentation may be linked to the infection rates. Basically, a higher risk surgical procedure may develop postoperative infections hence requiring a more conservative measure in the management of such infections.
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Choice of Antibiotics:
Select antibiotics based on:
Surgical Site: Some surgeries may pose frequent pathogens that are different from the common ones of a particular operation.
For instance, cefazolin is usually prescribed for clean surgeries, but certain regimens may require them for colorectal surgery, for example, cephalosporin with metronidazole.
Patient Factors: They involve drug allergy to the involved drugs, renal handling of the drugs under consideration and local resistance pattern.
Patient Factors Comorbidities: Assess parameters that can increase total risk of infections as a condition such as diabetes or obesity. Immunosuppression: Therapies required for special consideration patients on immunosuppressive therapy.
Monitoring and Adjustment: Supervising for infection and performance of the antibiotics used in the treatment.
Change the antibiotic administration depending on the result of the culture and effect in the patient.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
lifestyle-modifications-in-surgical-prophylaxis
Sterile Environment
Operating Room Cleanliness: Each operating room should be cleaned and disinfected frequently enough so that the pathogen in the rooms is lowered.
Air Quality: Use HEPA to reduce levels of bacteria that are in the air. Control of temperature and Humidity:
Optimal Temperature: Another strategy is prevention of bacteria growth which may be done through intensifying the low temperatures on the operating room.
 Humidity Levels: Minimizing dampness to minimize the cases of mold or bacteria formation.
Surgical Site Preparation Hair Removal:
It is recommended to perform few measures in the operation area to avoid the development of infectious processes.
Reduce the amount of hair removal at the operation site to prevent infections.
Skin Antisepsis: Before carrying out the surgery, skin antiseptic solutions should be used like Chlorhexidine etc.
Effectiveness of Antibiotics in surgical prophylaxis
First generation Cephalosporins
Cefazolin: Most used for clean and clean contaminated operations inclusive of orthopedics, cardiothoracic, and general operations. Second-generation Cephalosporins
Cefuroxime: Sometimes used in certain surgical settings, upper respiratory or intra-abdominal infections.
Vancomycin: Given to patients who are likely to develop MRSA infections or when the patient is involved in an operation that is expected to involve prosthetic material.
Clindamycin: A second-line antibiotic for patients with penicillin intolerance, especially in operations related to the gut or skin.
Metronidazole: May be used as part of the combination therapy for the surgical prophylaxis of the GI system, for instance, colorectal surgery.
Fluoroquinolones
Ciprofloxacin: May be useful in some cases, mostly would urological procedures or in case of allergies to the other groups of antibiotics.
Antibiotic Prophylaxis Procedure: Any surgical procedures, especially where the implant is involved such as orthopedic operations, cardio surgery and certain abdominal operations.
Intervention: Use of the right antibiotics in early times of surgery, preferably one hour before starting an incision.
The choice of antibiotic is based on the most common pathogens associated with the procedure.
Preoperative Skin Preparation
Procedure: Any type of operation that involves incision of the skin. Intervention: Chlorhexidine or iodine preparations used for skin and surgical site during operation.
Steroid Prophylaxis Procedure: Surgeries likely to cause an inflammatory response for example, cardiac surgeries involve procedures with high-risk association with inflammation.
Intervention: Corticosteroids were used to decrease the intensity of inflammation, thus, to increase the process of tissue repairing.
role-of-management-in-surgical-prophylaxis
Check the patient’s general health and health status, presence of primary disease prerequisites and infection permissiveness.
Antibiotic Selection: Chose the correct Prophylactic antibiotic that can be appropriate for the type of surgery done as well as any allergies.
Timing: The antibiotic should be administered within 60 minutes before the time of the surgical intervention.
Intraoperative Phase Administration:
Ensure that the prophylactic antibiotic was given as planned if not already administered.
 Monitoring: Supervising for signs of allergy and other side effects which may be attributed to operation.
Surgical Technique: Take precautions that will lower infection instances and shorten surgery time for the lowest risk.
Continuation: Decide on further doses according to type of surgery and presence of any problems.
Monitoring for Infection: Monitor the surgical site for signs of infection daily, or at least weekly (i.e., pain, erythema, oedema and exudate).
Patient Education: You must then educate the patient on the nature of an infection and what follow up they are likely to need.
During therapy, increase and maintain antithrombin activity within 80-120% (0.8-1.2 International Units/mL)
Loading dose should target 100% antithrombin activity level based on weight & pre-treatment antithrombin activity level Surgical Patients
Initial dosage should increase antithrombin levels to 120%.
Loading dose = [(120 - baseline antithrombin activity level in %) x kg Body Weight]/1.4 = units of antithrombin needed intravenous
Maintenance
Target subsequent dosage to maintain levels between 80 to 120%, which can be achieved by giving 60% of the initial loading dose every 24 hours.
Therapy can be modified by altering the dosage or interval.
Maintain the target level for 2-8 days, depending on the procedure or situation.
(Off-label) Dosage Modifications
GFR below 10 mL/min/1.73m²: Give every 2-3 days
GFR 10 to 29 mL/min/1.73m²: Give every 18-24 hours
GFR 30 to 50 mL/min/1.73m²: Give every 12-18 hours
GFR above 50 mL/min/1.73m²: dosage adjustment is not required
2 mg/kg/dose of intermittent haemodialysis repeat dose as needed based on concentration of serum
2 mg/kg/dose of peritoneal dialysis repeat do:
2.5 mg/kg intravenous/intramuscular 1 hour before surgery or with no antibiotics which is procedure dependent
Surgical prophylaxis involved the use of antibiotics at the time of surgery to avoid subsequent colonization of pathogens at the surgery site, also known as surgical site infection. It is well documented that SSIs are among most primary postoperative complications, which contribute to worsening of morbidity, increased length of hospital stay, and total cost of treatment. Prevention stands well used one of the approaches that can effectively reduce incidence rates in situations with high likelihood of contamination.
SSIs make up about 20% of total healthcare-associated infections globally. Centers for Disease Control and Prevention (CDC) approximate that SSIs affect 2-5 % of inpatient procedures in the United States.
Risk Factors for SSIs:
Patient-related factors: The main predisposing factors towards a higher risk of infections are diabetes, obesity, tobacco use, a weaker immune system, advanced age, and malnutrition.
Surgery-related factors:
Prolonged procedures contaminated operating procedures, operations for urgencies, and operations in which prosthetic devices are to be used.
Healthcare factors: Failure to adhere to certain infections controls measures, poor sterilization of the surgical instruments, wrong choice or time for antibiotic use leads to the high infection rates.
Microbial Contamination Sources: There are two routes through which microbes can be introduced during surgery; from the patient skin, the operating environment or the instruments used. This is usually caused by the bacteria that are normally found in our skin known as Staphylococcus aureus. However, gram-negative bacteria and anaerobes depending on the region of surgery may also be involved also.
Colonization and infection: The bacteria which gets into the body during surgery settles at the site of injury may attach themselves and multiply if they overcome the immune system.
The size of the inoculum, the degree of pathogenicity and the amount of oxygen present in the tissues determine whether colonization becomes an infection.
Host Immune Response Inflammatory Response: The human body has some natural barriers, including eliciting an immune response which accustoms the body to neutrophils and macrophages. Nevertheless, taking antiretroviral drugs or experiencing diabetes, obesity or any other circumstances the immune response is compromised.
Local Tissue Response: Surgery leads to tissue ischemia that means local blood supply and oxygen delivery are decreased.
Inadequate oxygen supply can also suppress immunocytes and inhibits the rate of tissue repair therefore increasing the risk of infection at the site.
Antibiotic Prophylaxis:
Timing and Selection: Systemic antibiotics are started before making the incision of the skin, such that the concentration of tissue at the time of surgery is maximized.
Selection of antibiotics: It is done according to the expected pathogens in the surgery for example cefazolin for skin flora of clean surgery. Mechanism: Using antibiotics implies the suppression of bacterial proliferation or destruction of bacteria on which the bases for infection do not develop.
They are not a sterile technique but minimize the occurrence of SSIs.
Host Factors Immune Status: Immunosuppressive therapy, malnutrition, or chronic diseases like diabetes can impair the host’s ability to fight off infection.
Age: Older individuals have a slower immune response and longer time to healing which raises the SSI risk.
Bacterial Contamination
Endogenous sources: Some of the patient’s flora that can potentially cause infection include skin, respiratory, gastrointestinal, or genitourinary flora.
Exogenous sources: Pathogens or other contaminants from the operating room environment, from surgical instruments, or the operating surgical team.
Types of Bacteria:
Gram-positive organisms: The organisms most frequently involved are Staphylococcus aureus including methicillin-resistant S aureus; coagulase-negative staphylococci; other bacteria involved include enterococci and Streptococcus species.
Gram-negative organisms: They are practiced often in cases of gastrointestinal or genitourinary tracts including Escherichia coli or Klebsiella species.
Risk Factors for Infection Type of surgery: There is a risk which applies to all the surgeries and the contaminated as well as the dirty surgeries which are categorically different.
Patient factors: A patient characteristic or condition that increases the likelihood of infection is known as risk factor and include age, obesity, diabetes, immune state, and malnutrition.
Surgical technique: Surgical duration also plays a part in infection rates and sterilization of instruments also.
Antibiotic Resistance: Skin prophylactic use of broad-spectrum antibiotics such as cefazolin may lead to acute infection by a resistant organism such as MRSA or ESBL bacteria.
Timing of Prophylaxis: Surgical prophylaxis requires the administration of the antibiotic at a particular time before an operation (in most cases before making the first incision less than 30-60 minutes).
Age Group:
Adults: In most cases, standard protocols are used for most adult patients.
Older adults: These patients have a different pharmacokinetics and may need their dose to be adjusted or given a different prophylactic agent owing to their renal or liver disease.
General assessment
Medical history
Other diagnostic tests
Diabetes Mellitus
Obesity
Cardiovascular Disease
Immunocompromised State
Chronic Lung Disease
Type of Surgery: The acuity is also based on the surgery type.
Elective procedures generally make it possible to implement good preventive measures, whereas urgent or even emergency surgical procedures may entail decisions about prophylaxis during, or immediately before, surgery.
Patient Factors:
Known medical conditions, history of infection, and general conditions like diabetes, obesity and immunosuppression can influence the decision-making process for surgical prophylaxis.
Infection Rates: It is possible that the severity of presentation may be linked to the infection rates. Basically, a higher risk surgical procedure may develop postoperative infections hence requiring a more conservative measure in the management of such infections.
Choice of Antibiotics:
Select antibiotics based on:
Surgical Site: Some surgeries may pose frequent pathogens that are different from the common ones of a particular operation.
For instance, cefazolin is usually prescribed for clean surgeries, but certain regimens may require them for colorectal surgery, for example, cephalosporin with metronidazole.
Patient Factors: They involve drug allergy to the involved drugs, renal handling of the drugs under consideration and local resistance pattern.
Patient Factors Comorbidities: Assess parameters that can increase total risk of infections as a condition such as diabetes or obesity. Immunosuppression: Therapies required for special consideration patients on immunosuppressive therapy.
Monitoring and Adjustment: Supervising for infection and performance of the antibiotics used in the treatment.
Change the antibiotic administration depending on the result of the culture and effect in the patient.
Sterile Environment
Operating Room Cleanliness: Each operating room should be cleaned and disinfected frequently enough so that the pathogen in the rooms is lowered.
Air Quality: Use HEPA to reduce levels of bacteria that are in the air. Control of temperature and Humidity:
Optimal Temperature: Another strategy is prevention of bacteria growth which may be done through intensifying the low temperatures on the operating room.
 Humidity Levels: Minimizing dampness to minimize the cases of mold or bacteria formation.
Surgical Site Preparation Hair Removal:
It is recommended to perform few measures in the operation area to avoid the development of infectious processes.
Reduce the amount of hair removal at the operation site to prevent infections.
Skin Antisepsis: Before carrying out the surgery, skin antiseptic solutions should be used like Chlorhexidine etc.
First generation Cephalosporins
Cefazolin: Most used for clean and clean contaminated operations inclusive of orthopedics, cardiothoracic, and general operations. Second-generation Cephalosporins
Cefuroxime: Sometimes used in certain surgical settings, upper respiratory or intra-abdominal infections.
Vancomycin: Given to patients who are likely to develop MRSA infections or when the patient is involved in an operation that is expected to involve prosthetic material.
Clindamycin: A second-line antibiotic for patients with penicillin intolerance, especially in operations related to the gut or skin.
Metronidazole: May be used as part of the combination therapy for the surgical prophylaxis of the GI system, for instance, colorectal surgery.
Fluoroquinolones
Ciprofloxacin: May be useful in some cases, mostly would urological procedures or in case of allergies to the other groups of antibiotics.
Antibiotic Prophylaxis Procedure: Any surgical procedures, especially where the implant is involved such as orthopedic operations, cardio surgery and certain abdominal operations.
Intervention: Use of the right antibiotics in early times of surgery, preferably one hour before starting an incision.
The choice of antibiotic is based on the most common pathogens associated with the procedure.
Preoperative Skin Preparation
Procedure: Any type of operation that involves incision of the skin. Intervention: Chlorhexidine or iodine preparations used for skin and surgical site during operation.
Steroid Prophylaxis Procedure: Surgeries likely to cause an inflammatory response for example, cardiac surgeries involve procedures with high-risk association with inflammation.
Intervention: Corticosteroids were used to decrease the intensity of inflammation, thus, to increase the process of tissue repairing.
Check the patient’s general health and health status, presence of primary disease prerequisites and infection permissiveness.
Antibiotic Selection: Chose the correct Prophylactic antibiotic that can be appropriate for the type of surgery done as well as any allergies.
Timing: The antibiotic should be administered within 60 minutes before the time of the surgical intervention.
Intraoperative Phase Administration:
Ensure that the prophylactic antibiotic was given as planned if not already administered.
 Monitoring: Supervising for signs of allergy and other side effects which may be attributed to operation.
Surgical Technique: Take precautions that will lower infection instances and shorten surgery time for the lowest risk.
Continuation: Decide on further doses according to type of surgery and presence of any problems.
Monitoring for Infection: Monitor the surgical site for signs of infection daily, or at least weekly (i.e., pain, erythema, oedema and exudate).
Patient Education: You must then educate the patient on the nature of an infection and what follow up they are likely to need.
Surgical prophylaxis involved the use of antibiotics at the time of surgery to avoid subsequent colonization of pathogens at the surgery site, also known as surgical site infection. It is well documented that SSIs are among most primary postoperative complications, which contribute to worsening of morbidity, increased length of hospital stay, and total cost of treatment. Prevention stands well used one of the approaches that can effectively reduce incidence rates in situations with high likelihood of contamination.
SSIs make up about 20% of total healthcare-associated infections globally. Centers for Disease Control and Prevention (CDC) approximate that SSIs affect 2-5 % of inpatient procedures in the United States.
Risk Factors for SSIs:
Patient-related factors: The main predisposing factors towards a higher risk of infections are diabetes, obesity, tobacco use, a weaker immune system, advanced age, and malnutrition.
Surgery-related factors:
Prolonged procedures contaminated operating procedures, operations for urgencies, and operations in which prosthetic devices are to be used.
Healthcare factors: Failure to adhere to certain infections controls measures, poor sterilization of the surgical instruments, wrong choice or time for antibiotic use leads to the high infection rates.
Microbial Contamination Sources: There are two routes through which microbes can be introduced during surgery; from the patient skin, the operating environment or the instruments used. This is usually caused by the bacteria that are normally found in our skin known as Staphylococcus aureus. However, gram-negative bacteria and anaerobes depending on the region of surgery may also be involved also.
Colonization and infection: The bacteria which gets into the body during surgery settles at the site of injury may attach themselves and multiply if they overcome the immune system.
The size of the inoculum, the degree of pathogenicity and the amount of oxygen present in the tissues determine whether colonization becomes an infection.
Host Immune Response Inflammatory Response: The human body has some natural barriers, including eliciting an immune response which accustoms the body to neutrophils and macrophages. Nevertheless, taking antiretroviral drugs or experiencing diabetes, obesity or any other circumstances the immune response is compromised.
Local Tissue Response: Surgery leads to tissue ischemia that means local blood supply and oxygen delivery are decreased.
Inadequate oxygen supply can also suppress immunocytes and inhibits the rate of tissue repair therefore increasing the risk of infection at the site.
Antibiotic Prophylaxis:
Timing and Selection: Systemic antibiotics are started before making the incision of the skin, such that the concentration of tissue at the time of surgery is maximized.
Selection of antibiotics: It is done according to the expected pathogens in the surgery for example cefazolin for skin flora of clean surgery. Mechanism: Using antibiotics implies the suppression of bacterial proliferation or destruction of bacteria on which the bases for infection do not develop.
They are not a sterile technique but minimize the occurrence of SSIs.
Host Factors Immune Status: Immunosuppressive therapy, malnutrition, or chronic diseases like diabetes can impair the host’s ability to fight off infection.
Age: Older individuals have a slower immune response and longer time to healing which raises the SSI risk.
Bacterial Contamination
Endogenous sources: Some of the patient’s flora that can potentially cause infection include skin, respiratory, gastrointestinal, or genitourinary flora.
Exogenous sources: Pathogens or other contaminants from the operating room environment, from surgical instruments, or the operating surgical team.
Types of Bacteria:
Gram-positive organisms: The organisms most frequently involved are Staphylococcus aureus including methicillin-resistant S aureus; coagulase-negative staphylococci; other bacteria involved include enterococci and Streptococcus species.
Gram-negative organisms: They are practiced often in cases of gastrointestinal or genitourinary tracts including Escherichia coli or Klebsiella species.
Risk Factors for Infection Type of surgery: There is a risk which applies to all the surgeries and the contaminated as well as the dirty surgeries which are categorically different.
Patient factors: A patient characteristic or condition that increases the likelihood of infection is known as risk factor and include age, obesity, diabetes, immune state, and malnutrition.
Surgical technique: Surgical duration also plays a part in infection rates and sterilization of instruments also.
Antibiotic Resistance: Skin prophylactic use of broad-spectrum antibiotics such as cefazolin may lead to acute infection by a resistant organism such as MRSA or ESBL bacteria.
Timing of Prophylaxis: Surgical prophylaxis requires the administration of the antibiotic at a particular time before an operation (in most cases before making the first incision less than 30-60 minutes).
Age Group:
Adults: In most cases, standard protocols are used for most adult patients.
Older adults: These patients have a different pharmacokinetics and may need their dose to be adjusted or given a different prophylactic agent owing to their renal or liver disease.
General assessment
Medical history
Other diagnostic tests
Diabetes Mellitus
Obesity
Cardiovascular Disease
Immunocompromised State
Chronic Lung Disease
Type of Surgery: The acuity is also based on the surgery type.
Elective procedures generally make it possible to implement good preventive measures, whereas urgent or even emergency surgical procedures may entail decisions about prophylaxis during, or immediately before, surgery.
Patient Factors:
Known medical conditions, history of infection, and general conditions like diabetes, obesity and immunosuppression can influence the decision-making process for surgical prophylaxis.
Infection Rates: It is possible that the severity of presentation may be linked to the infection rates. Basically, a higher risk surgical procedure may develop postoperative infections hence requiring a more conservative measure in the management of such infections.
Choice of Antibiotics:
Select antibiotics based on:
Surgical Site: Some surgeries may pose frequent pathogens that are different from the common ones of a particular operation.
For instance, cefazolin is usually prescribed for clean surgeries, but certain regimens may require them for colorectal surgery, for example, cephalosporin with metronidazole.
Patient Factors: They involve drug allergy to the involved drugs, renal handling of the drugs under consideration and local resistance pattern.
Patient Factors Comorbidities: Assess parameters that can increase total risk of infections as a condition such as diabetes or obesity. Immunosuppression: Therapies required for special consideration patients on immunosuppressive therapy.
Monitoring and Adjustment: Supervising for infection and performance of the antibiotics used in the treatment.
Change the antibiotic administration depending on the result of the culture and effect in the patient.
Sterile Environment
Operating Room Cleanliness: Each operating room should be cleaned and disinfected frequently enough so that the pathogen in the rooms is lowered.
Air Quality: Use HEPA to reduce levels of bacteria that are in the air. Control of temperature and Humidity:
Optimal Temperature: Another strategy is prevention of bacteria growth which may be done through intensifying the low temperatures on the operating room.
 Humidity Levels: Minimizing dampness to minimize the cases of mold or bacteria formation.
Surgical Site Preparation Hair Removal:
It is recommended to perform few measures in the operation area to avoid the development of infectious processes.
Reduce the amount of hair removal at the operation site to prevent infections.
Skin Antisepsis: Before carrying out the surgery, skin antiseptic solutions should be used like Chlorhexidine etc.
First generation Cephalosporins
Cefazolin: Most used for clean and clean contaminated operations inclusive of orthopedics, cardiothoracic, and general operations. Second-generation Cephalosporins
Cefuroxime: Sometimes used in certain surgical settings, upper respiratory or intra-abdominal infections.
Vancomycin: Given to patients who are likely to develop MRSA infections or when the patient is involved in an operation that is expected to involve prosthetic material.
Clindamycin: A second-line antibiotic for patients with penicillin intolerance, especially in operations related to the gut or skin.
Metronidazole: May be used as part of the combination therapy for the surgical prophylaxis of the GI system, for instance, colorectal surgery.
Fluoroquinolones
Ciprofloxacin: May be useful in some cases, mostly would urological procedures or in case of allergies to the other groups of antibiotics.
Antibiotic Prophylaxis Procedure: Any surgical procedures, especially where the implant is involved such as orthopedic operations, cardio surgery and certain abdominal operations.
Intervention: Use of the right antibiotics in early times of surgery, preferably one hour before starting an incision.
The choice of antibiotic is based on the most common pathogens associated with the procedure.
Preoperative Skin Preparation
Procedure: Any type of operation that involves incision of the skin. Intervention: Chlorhexidine or iodine preparations used for skin and surgical site during operation.
Steroid Prophylaxis Procedure: Surgeries likely to cause an inflammatory response for example, cardiac surgeries involve procedures with high-risk association with inflammation.
Intervention: Corticosteroids were used to decrease the intensity of inflammation, thus, to increase the process of tissue repairing.
Check the patient’s general health and health status, presence of primary disease prerequisites and infection permissiveness.
Antibiotic Selection: Chose the correct Prophylactic antibiotic that can be appropriate for the type of surgery done as well as any allergies.
Timing: The antibiotic should be administered within 60 minutes before the time of the surgical intervention.
Intraoperative Phase Administration:
Ensure that the prophylactic antibiotic was given as planned if not already administered.
 Monitoring: Supervising for signs of allergy and other side effects which may be attributed to operation.
Surgical Technique: Take precautions that will lower infection instances and shorten surgery time for the lowest risk.
Continuation: Decide on further doses according to type of surgery and presence of any problems.
Monitoring for Infection: Monitor the surgical site for signs of infection daily, or at least weekly (i.e., pain, erythema, oedema and exudate).
Patient Education: You must then educate the patient on the nature of an infection and what follow up they are likely to need.
Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.
Digital Certificate PDF
On course completion, you will receive a full-sized presentation quality digital certificate.
medtigo Simulation
A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.
medtigo Points
medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
Community Forum post/reply = 5 points
*Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.
All Your Certificates in One Place
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
