Therapeutics - Nosocomial/Surgical prophylaxis 2

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Author:
kyleannkelsey
ID:
287050
Filename:
Therapeutics - Nosocomial/Surgical prophylaxis 2
Updated:
2014-10-25 18:11:57
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Therapeutics Nosocomial Surgical prophylaxis
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Therapeutics - Nosocomial/Surgical prophylaxis
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Therapeutics - Nosocomial/Surgical prophylaxis
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  1. What are the risk factors for surgical site infection?
    • Age extremes
    • Malnourishment
    • Obeisity
    • Immunosupression
    • Prolonged hospitalization
    • No preoperative shower
    • Hair removal
    • Prior antibiotic therapy
    • Wound contamination
    • Prolonged procedure
    • Traumatic wound
    • Foreign material
    • Wound drainage
    • Intraop hypotension
  2. What is a Clean surgical site?
    • Uninfected operative wound without inflammation
    • Excludes sites involving respiratory, alimentary, genital and uninfected urinary tracts
  3. What is a Clean-contaminated surgical site?
    • Sites involving respiratory, alimentary, genital and uninfected urinary tracts
    • Under controlled conditions without contamination
  4. What is a contaminated surgical site?
    Fresh open wound or break in the sterile technique or gross spill from the GI tract
  5. What is a dirty /infected surgical site?
    Old traumatic wound with devitalized tissue and those with existing infection or perforated viscera. Organisms were likely present at time of surgery
  6. What Cleanliness classifications of the surgical site indicate a need for prophylactic antibiotic therapy?
    • Clean-contaminated
    • Contaminated
  7. What Cleanliness classifications of the surgical site indicate a need for treatment level antibiotic therapy?
    Dirty/infected
  8. What Cleanliness classifications of the surgical site indicates that antibiotic prophylaxis is not needed?
    Clean
  9. What are the most common organisms of surgical wounds?
    • Coagulase negative staph
    • Staph aureus
    • Pseudomonas aeruginoasa
    • Enterococci
    • E. coli
    • (Can Surgical Prophylaxis Eliminate Everything)
  10. When must therapeutic concentrations of antibiotics be present in a surgical patient, and thus when must they be administered?
    • At the time of incision and throughout the entire procedure
    • Administered w/in 60 minutes of incision
    • Vanco/flouroquinolones require longer infusion times = start 1-2 hours (2-3 in obese) prior to incision
  11. What level of antibiotics is required throughout the entire procedure for prphylaxis?
    Bactericidal
  12. How often should Cefazolin be administered for surgical prophylaxis?
    Q4H
  13. How often should Cefoxitin be administered for surgical prophylaxis?
    Q2H
  14. How often should Clindamycin be administered for surgical prophylaxis?
    Q6H
  15. How often should Metronidazole be administered for surgical prophylaxis?
    Long Half Life – does not require re-dosing
  16. How often should Vancomycin be administered for surgical prophylaxis?
    Long Half Life – does not require re-dosing
  17. How often should Ciprofloxacin be administered for surgical prophylaxis?
    Long Half Life – does not require re-dosing
  18. When do surgical prophylaxis antibiotics need to be stopped?
    24 hours after the procedure
  19. What is the dose/interval for Cefazolin when used for prophylaxis for gastroduodenal, biliary tract, urologic, neurosurgical or hysterectomy?
    1 gram x1
  20. What is the dose/interval for Cefazolin when used for prophylaxis for vascular, head and neck and joint replacement?
    1 gram induction dose then Q8H x 2 doses
  21. What is the dose/interval for Cefazolin when used for prophylaxis for Hip repair?
    1 gram at induction then Q8H x 24 hours
  22. What is the dose/interval for Cefoxitin when used for prophylaxis for intact appendectomy?
    1 gram x1
  23. What is the antibiotic regimen used for prophylaxis for colorectal surgery?
    • Oral neomycin 1 gram + erythromycin 1 gram x 3 doses prior to procedure
    • +/- Metronidazole 1 gram + bowel prep + cefoxitin 1 gram x1
  24. Cephalosporins may be given in the absence of _______,_______,__________,________ and __________
    Hives, anaphylaxis, SOB, Steven-Johnson syndrome and toxic epidural necrolysis
  25. What is the alternative treatment for PCN and Cephalosporin allergic patients undergoing a clean procedure?
    • Clindamycin
    • Vancomycin
  26. What is the alternative treatment for PCN and Cephalosporin allergic patients undergoing GI procedures?
    • Metronidazole or Clindamycin for anerobic coverage
    • Ciprofloxacin for G- coverage
  27. What is the alternative treatment for PCN and Cephalosporin allergic patients undergoing a GU procedure?
    Ciprofloxacin
  28. What topical products are available to prophylactically reduce MRSA risk after a procedure?
    • Mupirocin 2% (Bactroban)Intranasal BID for patients colonized with MRSA
    • Chlorhexadrine scrub
  29. SCIP (Surgical care improvement project) has what function?
    • Quality improvement project to reduce overuse of antibiotics in surgical prophylaxis
    • Limits antibiotic use to 24 hours after procedure

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