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Antimicrobial Prophylaxis in Surgery

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Key Points ÎÎProphylaxis refers to the prevention of an infection and can be characterized as primary prophylaxis, secondary prophylaxis, or eradication. These guidelines focus on primary perioperative prophylaxis — the prevention of an initial infection. ÎÎProphylaxis is recommended in some cases due to the severity of complications of postoperative infection (eg, an infected device that is not easily removable) necessitating precautionary measures even if infection is unlikely. ÎÎPatient-related factors associated with an increased risk of surgical site infection (SSI) include extremes of age, nutritional status, obesity, diabetes mellitus, tobacco use, coexistent remote body site infections, altered immune response, corticosteroid therapy, recent surgical procedure, length of preoperative hospitalization, and colonization with microorganisms. •  Antimicrobial prophylaxis may be justified for any procedure if the patient has an underlying medical condition associated with a high risk of SSI or if the patient is immunocompromised (eg, malnourished, neutropenic, receiving immunosuppressive agents). ÎÎAlthough antimicrobial prophylaxis plays an important role in reducing the rate of SSIs, other factors may have a strong impact on SSI rates. These include: •  Attention to basic infection control strategies •  The surgeon's experience and technique •  Duration of procedure •  Hospital and operating room environments •  Instrument sterilization •  Preoperative preparation (eg, surgical scrub, skin antisepsis, and appropriate   hair removal) •  Perioperative management (temperature and glycemic control) •  The underlying medical condition of the patient Definitions National Healthcare Safety Network (NHSN) Wound Classification Criteria ÎÎClean: An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tracts are not entered. •  In addition, clean wounds are closed primarily and, if necessary, drained with closed drainage. •  Operative incisional wounds that follow nonpenetrating (blunt) trauma should be included in this category if they meet the criteria.

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