Infection postoperative, prevention

Because of its acidity, phenol was known as carbolic acid when Joseph Lister introduced it as an antiseptic in 1865 to prevent postoperative bacterial infections that were then a life-threatening hazard in even minor surgical procedures. 

The cephalosporins also may be used perioperatively, that is, during the preoperative, intraoperative, and postoperative periods, to prevent infection in patients having surgery on a contaminated or potentially contaminated area, such as the gastrointestinal tract or vagina In some instances, a specific drug may be recommended for postoperative prophylactic use only. 

Prophylaxis-To prevent postoperative infection in clean contaminated or potentially contaminated surgery in adults, give a single 1 or 2 g IV dose 30 to 60 minutes prior to surgery. In patients undergoing cesarean section, give the dose as soon as the umbilical cord is clamped. 

Prophylaxis To prevent postoperative infection in contaminated or potentially contaminated colorectal surgery, the recommended adult dosage is 15 mg/kg infused over 30 to 60 minutes and completed about 1 hour before surgery followed by 7.5 mg/kg infused over 30 to 60 minutes at 6 and 12 hours after the initial dose. Complete administration of the initial preoperative dose about 1 hour before surgery so that adequate drug levels are present in the serum and tissues at the time of initial incision, and administer, if necessary, at 6-hour intervals to maintain effective drug levels. Limit prophylactic use to the day of surgery only. 

Gyssens 1C. Prevention of postoperative infections current treatment recommendations. Drugs 1999 57 175-85. 

Use of systemic antibiotics should be limited to infectious or pronounced superinfected wounds. Only few situations in dermatologic surgery require prophylactic antibiotics, since in cutaneous surgery postoperative infections are too infrequent and insufficiently severe to justify preventive antibiotics. 

Primary eye care providers may collaborate with ophthalmic surgeons to comanage the cataract patient. This method of eye care delivery provides quality care for the patient in convenient familiar surroundings. In addition, it is efficient and cost-effective. The goals of the comanagement team during postoperative care are those of everyday optometric practice to educate and reassure the patient, to prevent infection, to control inflammation, to maintain desired intraocular pressure (lOP), to manage complications if they arise, to control pain, and to optimize vision. 

Many practitioners believe that prevention of postoperative infection begins with preoperative management of the cataract patient. Some advocate the use of eyelid scrubs or a topical broad-spectrum antibiotic fiar several days before surgery. This is particularly important with patients who have preexisting conditions, such as conjunctivitis, dacryocystitis, or chronic bacterial blepharitis. Ophthalmic surgeons often administer topical antibiotics within 1 to 2 hours preoperatively to prevent woimd infection. 

There is a preponderance of evidence that the incidence of postoperative endophthalmitis is reduced when antiseptics (povidone iodine) and antibiotics are used preoperatively.The use of balanced salt solution, to which an antibiotic has been added, to irrigate the eye during surgery is advocated by some but tempered by concerns of intraocular toxicity and questions of efficacy. Sub-Tenon s capsule injection of an antibiotic just before surgery or subconjunctival injection of antibiotic at the end of the surgery is also used to prevent infection, but risk of inadvertent intraocular injections resulting in retinal antibiotic toxicity must be considered. In addition, oral antibiotics may be used at the time of surgery and 1 day postoperatively as a prophylactic measure. 

Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, PfaUer MA, Sheppard D, Twombley J, French PP, Herwaldt LA Mupirocin And The Risk Of Staphylococcus Aureus Study Team. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002 346(24) 1871-7. 

Emergent surgical intervention, mainly an abdominal colectomy with formation of an ileostomy, is an important consideration in patients with toxic megacolon and prevents death in some patients. In most cases in which colectomy is performed in the face of toxic megacolon, there is a significant risk of operative complications, including postoperative infection. 

The recommendations and literature reviewed in this chapter show that SSls are preventable with appropriately chosen and timed prophylactic therapy in combination with meticulous aseptic technique and a variety of nonantimicrobial methods. Despite this, infection is the most common complication postoperatively. For this... 

As discussed earlier, the incidence of postoperative infection remains a major issue, often with dire conseqnences following implantation. Titanium implants are widely used clinically bnt also suffer from this issue. Therefore, surfaces with antibacterial coatings are extranely desirable. Research has demonstrated that incorporation of silver nanoparticles into titanium nanotubes enable such effects. Zhao et al. [51] showed adequate activity against planktonic bacteria within several days and preventing their subsequent growth for np to 30 days. 

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