ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery

1
E.R. Reyes
ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery
2
E.R. Reyes


ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery
3
E.R. Reyes
Goals of Surgical Prophylaxis
1. Prevent postoperative infection of the surgical site
2. Prevent postoperative infectious morbidity and mortality
3. Reduce the duration and cost of health care
4. Produce no adverse effects
a. Have no adverse consequence for the microbial flora of the
patient or the hospital

To achieve these, antimicrobials should be:
a. Active against the pathogens most likely to contaminate the wound
b. Given in appropriate dosage and at a time that ensures adequate
concentration at the incision site during the period of potential
contamination
c. Safe and administered for the shortest effective period to minimize
ADR, devt of resistance, and cost.

The modified National Research Council wound classification criteria as
follow:

Clean Surgical Procedures
primary closed, elective procedures involving no acute
inflammation, no break in technique, and no tansection of GI,
oropharyngeal, GU, biliary or tracheobronchial tracts

Clean-Contaminated Procedures
procedures involving transaction of GI, oropharyngeal, GU, biliary,
or tracheobronchial tracts with minimal spillage or with minor
breaks in technique
clean procedures performed emergently or with major breaks in
technique
reoperation of clean surgery within seven days
procedures following blunt trauma




Contaminated Procedures
Clean-contaminated procedures during which acute, nonpurulent
inflammation is encountered or major spillage or technique break
occurs
Procedures performed within four hours of penetrating trauma or
involving a chronic open wound

Dirty Procedures
Procedure performed when there is obvious pre-existing infection
o Presence of abscess, pus, necrotic tissue
Preoperative perforation of GI, oropharyngeal, biliary, or
tracheobronchial tracts
Penetrating trauma greater than four hours old

NOTE:
I. Prophylactic antimicrobials are not indicated for clean surgical
procedures
a. Only justified for procedures involving prosthetic placement
because of the potential for severe complications if
postoperative infections involve the prosthesis
II. The use of antimicrobials for dirty and contaminated procedures is
not classified as prophylaxis but as treatment for a presumed
infection