Surgery clean operations

Surgical procedures that necessitate the use of antimicrobial prophylaxis include contaminated and clean-contaminated operations, selected operations in which postoperative infection may be catastrophic such as open heart surgery, clean procedures that involve placement of prosthetic materials, and any procedure in an immunocompromised host. The operation should carry a significant risk of postoperative site infection or cause significant bacterial contamination. 

Clean-contaminated sites alimentary, genital, respiratory, or urinary operative sites that are without unusual contamination. Specifically, surgery involving the appendix, biliary tract, vagina, or oropharynx are categorized in this group. 

Attempts have been made to address these concerns by the introduction of the Work at Height Regulations which apply to all operations carried out at height not just construction work so that they are also relevant to, for example, window cleaning, tree surgery, maintenance work at height and the changing of street lamps. 

PDT has been used frequently as an adjuvant to surgery in an attempt to clean up the remaining cancer cells in the operative bed. Biel reported on five patients with recurrent infiltrating squamous cell carcinoma — all who had failed previous surgery, radiation therapy, and chemotherapy. Patients received 2 mg/kg Photofrin followed 2 days later by surgery and PDT at 50 J/cm. He reported no postoperative complications. With a follow-up of 18 to 30 months, only one patient had recurred in an area outside the surgical and PDT field. 

---