This policy has been produced in collaboration with each surgical directorate within the hospital. It has been produced to address issues of inappropriate antibiotic prescribing and the impact on drug resistance.
Prescribers should check within their own directorates if the policy has been updated as several are currently under review
Goals of antibiotic prophylaxis ¹
To reduce the incidence of surgical
site infection
To use
antibiotics in a manner that is supported by evidence of effectiveness
To minimise the
effect of antibiotics on the patient's normal bacterial flora
To minimise
adverse effects
To cause minimal change to the patient's host defences.
Principles of antibiotic prophylaxis ¹
The decision regarding the benefits and risks of prophylaxis for an individual patient will depend on:
The patient's risk of surgical site infection
The potential
severity of the consequences of surgical site infection
The effectiveness
of prophylaxis in that operation
The consequences of prophylaxis for that patient (e.g. increased risk of colitis)
The policy reflects professional
body recommendations, local antibiotic sensitivities, drug costs and
consultant experience.
The selected
antibiotic for prophylaxis must cover the common pathogens.
Patients with a
history of anaphylaxis, urticaria or rash occurring immediately after
penicillin therapy are at an increased risk of Immediate
hypersensitivity to penicillins and should not receive prophylaxis
with a beta-lactam antibiotic (refer to antibiotic guidelines).
Antibiotic
prophylaxis should be administered pre-operatively in most
circumstances (ideally within 30 minutes of the induction of
anaesthesia) or during a procedure.
In most cases
prophylactic antibiotics should be administered intravenously
(exceptions are specified within the policy)
An additional dose
of antibiotic may be indicated if surgery is prolonged or there is
blood loss during surgery of 1500ml or haemodilution of up to 15ml/kg.
Fluid replacement bags should not be primed with prophylactic antibiotics because of the potential risk of contamination and calculation errors.
USE OF PROPHYLACTIC ANTIBIOTICS DOES NOT SUBSTITUTE GOOD SURGICAL PRACTICE
Classification of operation ¹
|
CLASS DEFINITION |
|
|
Clean |
Operations in which no inflammation is encountered and the respiratory, alimentary or genitourinary tracts are not entered. There is no break in aseptic operating theatre technique |
|
Clean-contaminated |
Operations in which the respiratory, alimentary or genitourinary tracts are entered but without significant spillage. |
|
Contaminated |
Operations in which the respiratory, alimentary or genitourinary tracts are entered but without significant spillage. |
|
Dirty |
Operations in the presence of pus, where there is a previously perforated hollow viscus, or compound/open injuries more than four hours old. |