Preventing infections

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Cranial infection

Preventing infection

• Surgical site infection
• SBNS has guidance on surgical site infection

• Evidence
• Scrubbing: no trial exist
• Which agent to scrub with
• Chlorhex last longer because iodine stays in hand after 2 hrs and therefore has greater colonoscopies bacteria
• Using both Chlor and iodine together is better, RCSEng 2016 combination
• Duration of scrub
• 3mins
• Double gloves
• Single glove better than double but perforation of gloves rates are 78%

• Skin prep
• Alcoholic prep better than aqueous
• Only use aqueous when it is in wound
• Prep >3 times

Prophylactic antibiotics

• General
• Done use it > 24 hrs post op
• Use within 30 mins WHO before surgery starts
• Antibiotics must be in tissues at time of contamination (thus, avoid “on-call” antibiotics)
• Reduced infection by 63%
• Repeated administration is vital in prolonged procedures, 4hrs after.
• Typical infecting organisms are usually predictable. Coverage for these organisms is adequate (broadening spectrum is of no value)
• In low risk operations (e.g. carotid endarterectomy, where infections rare and seldom life-threatening) may cost more to prevent than to treat
• Prolongation of abx beyond 1st day post op provides no additional protection (may not be true for patients with drains)
• Theoretical side effects (alteration of patient’s flora, development of resistant strains in patient or hospital) have not been realised without prolonged administration of pre-op or post-op antibiotics
• Factors that increase risk of operative wound infection include
• Systemic factors: malnutrition, reoperation, infection at secondary site (especially UTI when GU tract manipulated), prolonged administration of antibiotics
• Local factors: epinephrine, dehydration, hypoxia

• Give for all surgery

• Give cefazolin + gentamicin 1 hr before incision then QDS for one day post op
• Showed to have significant reduce risk of infection without implantation

• Give for long procedures: cefazolin (1st gen)

Reducing infection risk

• Pre-op
• Optimising medical condition: glycemic control, smoking cessation, weight management (BMI<30),
• Pre-operative screening for MRSA

• Intraoperative
• Scrubbing
• Double vs single glove: no difference
• Double glove reduce shunt infection
• Skin prep
• Double glove and use just one after prep
• Antibiotics
• Temperature control: prevent hypothermia
• Operation>180 mins inc infection
• Staples inc. wound infection

• Post op
• Wound dressing
• Glycemic control
• Hba1c < 7