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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Discuss the epidemiology and impact of surgical site infections (SSIs) on patient outcomes and healthcare costs.

  2. Name and differentiate the four different types of wound classifications.

  3. Recognize at least three risk factors for postoperative SSIs.

  4. Identify likely pathogens associated with different surgical operations.

  5. Compare and contrast antimicrobials used for surgical prophylaxis and identify potential advantage and disadvantages for each antibiotic.

  6. Discuss the importance of β-lactam allergy screening and how this could impact resistance and healthcare costs.

  7. Identify nonantimicrobial methods that can reduce the risk of postoperative infection.

  8. Discuss the possible impact of antimicrobial-impregnated bone cement and how this affects the use of antimicrobial prophylaxis in surgery.

  9. Discuss the importance of timing, duration, and redosing in relation to antimicrobial prophylaxis in surgery.

  10. Recommend appropriate prophylactic antimicrobial(s) given a surgical operation.

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KEY CONCEPTS

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  • Image not available. Surgical site infections (SSIs) are a significant cause of morbidity and mortality.

  • Image not available. The distinction between prophylaxis and treatment influences the choice of antimicrobial and duration of therapy.

  • Image not available. Surgical operations are classified as clean, clean-contaminated, contaminated, or dirty.

  • Image not available. Choosing the appropriate prophylactic antimicrobial relies on anticipating which organisms are likely to be encountered during the operation.

  • Image not available. A thorough drug allergy history should be taken to discern true drug allergy (anaphylaxis) from other adverse events (stomach upset).

  • Image not available. For prevention of SSIs, correct timing of antimicrobial administration is imperative so as to allow the persistence of therapeutic concentrations in the blood and wound tissues during the entire course of the operation.

  • Image not available. The goal of antimicrobial dosing for surgical prophylaxis is to optimize the pharmacodynamic parameter of the selected agent against the suspected organism for the duration of the operation.

  • Image not available. The duration of antimicrobial prophylaxis should not exceed 24 hours (48 hours for cardiac surgery); additional doses of antimicrobial past this time point do not demonstrate added benefits.

  • Image not available. According to Centers for Disease Control and Prevention criteria, SSIs may appear up to 30 days after an operation and up to 1 year if a prosthesis is implanted.

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Image not available. Surgical site infections (SSIs) are a significant cause of morbidity and mortality. Approximately 2% to 5% of patients undergoing clean extra-abdominal operations and 20% undergoing intra-abdominal operations will develop an SSI.1 SSIs have become the second most common cause of nosocomial infection, and these data are likely underestimated.1 More than 70% of surgical procedures are now performed

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on an outpatient basis, creating a significant potential for under-reporting.2

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SSIs negatively affect patient outcomes and increase healthcare costs. Patients who develop SSIs are five times more likely to be readmitted to the hospital and have twice the mortality of patients who do not develop an SSI.1 A patient with an SSI is also 60% more likely to be admitted to an ICU.1 SSIs increase lengths of hospital stay and costs.1,3...

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