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Antimicrobial Prophylaxis in Surgery

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Key Points ÎÎOrgan/space SSI: involves any part of the body—excluding the skin incision, fascia, or muscle layers—that is opened or manipulated during the operative procedure. Specific sites are assigned to organ/space SSI to further identify the location of the infection (eg, endocarditis, endometritis, mediastinitis, vaginal cuff, and osteomyelitis). Organ/space SSI must meet the following criteria: a •  Infection occurs within 30 or 90 daysa after the operative procedure if no implant is in place or within 1 year if implant is in place and the infection appears to be related to the operative procedure, •  Infection involves any part of the body, excluding the skin incision, fascia, or muscle layers, that is opened or manipulated during the operative procedure, and •  The patient has at least one of the following: ▶▶ Purulent drainage from a drain that is placed through a stab wound into the organ/space. ▶▶ Organisms isolated from an aseptically obtained culture of fluid or tissue in the organ/space. ▶▶ An abscess or other evidence of infection involving the organ/space that is found on direct examination, during reoperation, or by histopathologic or radiologic examination. ▶▶ Diagnosis of an organ/space SSI by a surgeon or attending physician. See Table 1 Table 1. Surveillance Period for Deep Incisional or Organ/Space SSI Following Selected NHSN Operative Procedure Categoriesa 90-day Surveillance 30-day Surveillance Operative Site/Procedure a 2 Abdominal aortic aneurysm Abdominal hysterectomy Appendix Bile duct, liver or pancreas Carotid endarterectomy Colon Cesarean section Heart transplant Kidney Kidney transplant Laminectomy Limb amputation Liver transplant Neck Rectum Shunt for dialysis Small bowel Spleen Stomach Thorax Thyroid and/or parathyroid Vaginal hysterectomy Exploratory Laparotomy Ovary Gallbladder Prostate Other operative procedures not included in the NHSN categories Breast Hip prosthesis Peripheral vascular bypass Craniotomy Knee prosthesis Refusion of spine Heart Open reduction of fracture Spinal fusion Herniorrhaphy Pacemaker Ventricular shunt Coronary artery bypass graft with both chest and donor site incisions Coronary artery bypass graft with chest incision only Modified from the published guidelines to include recently updated definitions from the NHSN Centers for Disease Control and Prevention. Procedure-Associated Module: Surgical Site Infection Event. National Healthcare Safety Network Patient Safety Component. 2013 Jan. http://www.cdc. gov/nhsn/psc_pa.html (accessed 2013 Feb 14).

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