Phar 352 - Surgical Prophylaxis

Front 1

"Surgical Site Infections are the 3rd most common hospital acquired infection" True or False?

Back 1

TRUE

Front 2

What is the criteria of a Clean Surgical Wound?(3)

Back 2

1) No acute inflammation

2) No entry into: GI, Resp, GU, Billiary Tract

3) No break in aseptic technique

Front 3

What is the criteria of a Clean-Contaminated Surgical Wound?(3)

Back 3

1) Controlled opening of GI, Resp, Biliary or GU tracts

2) No significant spillage

3) Clean wounds with major break in aseptic technique

Front 4

What is the criteria of a Contaminated Surgical Wound?(4)

Back 4

1) Penetrating Trauma <4hrs

2) Major Technique break

3) Major spillage from GI tract

4) Acute nonpurulent Inflammation

Front 5

What is the criteria of a Dirty Surgical Wound?(3)

Back 5

1) Penetrating Trauma >4hrs

2)Purulence or Abscess

3) Preoperative perforation of viscera

Front 6

What is the infection rate of Clean Surgical Wound?

Back 6

<5%

Front 7

What is the infection rate of Clean-Contaminated Surgical Wound?

Back 7

<10%

Front 8

What is the infection rate of Contaminated Surgical Wound?

Back 8

15-20%

Front 9

What is the infection rate of Dirty Surgical Wound?

Back 9

30-40%

Front 10

What are the goals of therapy for a prophylaxis antimicrobials? (6)

Back 10

1) Decrease overall mortality

2) Decrease surgical infections

3) Decrease complications for surgical infections 4) Minimize unnecessary antibiotic use

5) Prevent Antibiotic resistance

6) Minimize ADRs from medications

Front 11

What are the Environmental Contamination risk factors for surgical site infections?(5)

Back 11

1) Operative Team

2) Instruments

3) Skill of Surgeon

4) Operation Duration

5) Degree of Bacterial contamination during surgery

Front 12

What are the Environmental Organism risk factors for surgical site infections?(4)

Back 12

1) Virulence of infecting organism

2) Airborne organisms

3) Inoculum size: (>10^5 organisms per gram of tissue)

4) Colonization: (prolonged hospital stay, prior use of antibiotics)

Front 13

What are the Patient risk factors for surgical site infections?(8)

Back 13

1) Microflora of Skin

2) Host defences

3) Age: (more likely if older)

4) Obesity

5) Malnutrition

6) Diabetes mellitus

7) Remote Infection

8) Nicotine Use

Front 14

What are the likely pathogens for surgical infections for Cardiac Surgery?(3)

Back 14

1) Staph aureus (MRSA)

2) Coagulase (-ve) Staph

3) Streptococci

Front 15

What are the likely pathogens for surgical infections for Bowel Surgery?(5)

Back 15

Skin Bugs gram (+ve)

1) Staph aureus

2) MRSA

3) Coagulase -ve Staph

4) Easy Gram -ve

5) Anaerobes

Front 16

What are the likely pathogens for surgical infections for Orthopedic Surgery?(3)

Back 16

1) Staph aureus (MRSA)

2) Coagulase (-ve) Staph

3) Streptococci

Front 17

What are the likely pathogens for surgical infections for Dental Procedures?(5)

Back 17

Gram (+ve):

1) Viridons group streptococci

Gram (-ve):

1) Eikenella corredens

2) Actinobacillus spp

Anaerobes:

1) Actinomyces spp

2) Peptostreptococcus

Front 18

When is prophalyxis for Cardiac Surgery recommended?(4)

Back 18

1) Cardiac Surgery

2) Prosthetic valves

3) Pacemaker Implants

Front 19

"Prophylaxis for Cadiac Catherization is recommended" True or False?

Back 19

FALSE

Front 20

When is prophalyxis for Bowel Surgery recommended?(5)

Back 20

1) Appendectomy

2) Emergency bowel surgery

3) Bowel Obstruction

4) Elective Colorectal surgery

5) Fistulas/Discontinue bowel segments

Front 21

When is prophalyxis for Gynecological Obstructional Surgery recommended?(1)

Back 21

1) Vaginal and Abdominal hysterectomy

Front 22

When is prophalyxis for Orthopedic Surgery recommended?(3)

Back 22

1) Joint Replacement (early/late)

2) Compound/Open fractures

3) Internal fixation

Front 23

"There is no benefit for prophylaxis of orthoscopic procedures" True or False?

Back 23

TRUE

Front 24

When is prophalyxis for Dental Procedures recommended?(3)

Back 24

1) Manipulation of Gingival Tissue

2) Manipulation of the Periodical region of teeth 3) Perforation of Oral Mucosa

Front 25

What are the pre-operation prophylaxis recommendation for Cardiac Surgery?

Back 25

1) Cefazolin 1g IV

2) Vancomycin 20mg/kg IV x 1day [if ceph allergy or MRSA]

Front 26

What are the post-operation prophylaxis recommendation for Cardiac Surgery?

Back 26

1) Cefazolin 1g IV q8h x 2doses

2) Vancomycin 20mg/kg IV q12h x 2 days [if ceph allergy or MRSA]

Front 27

What are the prophylaxis recommendations for Bowel Surgery?

Back 27

1) Cefazolin IV + Metronidazole IV x 1 dose

2) Clindamycin IV + Gentamicin IV x 1dose [if cephalosporin allergy]

Front 28

What are the prophylaxis recommendations for Hysterectomy?

Back 28

1) Cefazolin ± Metronidazole x 1dose

2) Clindamycin + Gentamicin x 1dose [if cepah allergy]

Front 29

What are the prophylaxis recommendations for Caseriaion Sections?

Back 29

1) Cefazolin 1g IV x 1 dose

2) Vancomycin 20mg/kg IV x 1dose [if ceph allergy]

Front 30

What are the prophylaxis recommendations for Orthopedic Surgery?

Back 30

1) Cefazolin q8h x 2days

2) Vancomycin 20mg/kg IV x 1 dose ± post op q12h x 2doses

Front 31

"With fractures and reconstructing limb surgery is treatment not prophylaxis" True or False

Back 31

TRUE

Front 32

What are the prophylaxis recommendations for Dental Procedures?

Back 32

1) Amoxicillin 2g PO 1hr Pre-Op

2) Clindamycin 300-450mg PO 1hr Pre-Op [if penicillin allergy]

Front 33

Who are the patients at risk of Dental Procedures? (4)

Back 33

1) With prosthetic cardiac valves

2) Recipients of Cardiac transplants who develop a problem with a heart valve

3) Previous bacterial endocarditis

4) Certain specific serious present from birth heart conditions

Front 34

Which birth heart conditions would put a patient at risk of infections to Dental Procedures?(3)

Back 34

1) Unrepaired Cyanotic Congenital Heart Defects 2) Repaired w/residual defects at sites adjacent to prosthetic patch/device

3) Congenital heart defects completely repaired with prosthetic material/device (6 months after)

Front 35

Which group of patients who undergo Dental Procedures used to be recommended prophylaxis but not anymore? (6)

Back 35

1) Mitrial & Aortic valve disease

2) Rhematic heart disease

3) Bicuspid valve disease

4) Calcified aortic stenosis

5) Structural disorders

6) Hypertrophic Cardiomyopathy

Front 36

Which group of patients who undergo Dental Procedures do not require prophylaxis?(5)

Back 36

1) Routine anesthetic through non-infected tissue 2) Dental Radiographs

3) Placement of removable prosthodentridic or orthodontic appliances

4) Shedding of deciduous teeth (baby teeth)

5) Bleeding from trauma to lips or mucosal membranes

Front 37

What is the typical duration of therapy of therapy for Surgical Prophylaxis?

Back 37

1) Initial Dose: Immediately prior (<30min) to skin lesions

2) Second Dose if either Prolonged surgery, Major blood loss, If the antibiotic half life is short

Front 38

What is the recommended dosing interval of Cefazolin intraoperatively?

Back 38

q4h

Front 39

What is the recommended dosing interval of Clindamycin intraoperatively?

Back 39

q4h

Front 40

What is the recommended dosing interval of Vancomycin intraoperatively?

Back 40

q8h

Front 41

"Vancomycin needs to be administered 1 hour prior to procedure" True or False?

Back 41

TRUE

Front 42

"Gentamicin is always given in combination, administered 30mins after start of procedure" True or False?

Back 42

FALSE

Front 43

Single dose prophylaxis is well established for which types of surgeries?(4)

Back 43

1) Biliary tract/Gastric

2) Colorectal

3) Vaginal Hysterectomy

4) TURP: Transurethral Resection of Prostate

Front 44

Prolonged therapy is recommended for which types of surgeries?(2)

Back 44

1) Drains/Catheters (cardiothoracic surgery)

2) Prosthetic Material (Orthopedic Surgery)