Antimicrobial prophylaxis prior to surgery in ADULTS

CLEAN Elective procedures where there is no sign of infection or inflammation. There is no breach of aseptic technique. The respiratory, alimentary, genital or urinary tracts are not penetrated.	NO PROPHYLAXIS REQUIRED
INSERTION OF IMPLANTS For orthopaedic and vascular surgery click on speciality (see below).	PROPHYLAXIS REQUIRED
CLEAN CONTAMINATED Non traumatic but respiratory, alimentary, genital or urinary tracts are penetrated. Minor spillage or only a minor breach in aseptic technique.	PROPHYLAXIS REQUIRED
CONTAMINATED Major break in aseptic technique. Major spillage from hollow viscus that may include non purulent material Dirty, traumatic wound, faecal contamination, foreign body, de-vitalised viscus. Pus encountered from any source during surgery.	TREATMENT REQUIRED (as per Trust antibiotic guidelines)

 

Prophylaxis

• The prophylactic antibiotic should be administered pre-operatively ideally within 30 minutes of the induction of anaesthesia
• Additional dose of prophylactic agent is not indicated unless there is a blood loss of greater then 1500ml during surgery, haemodilution of greater than 15ml/kg or prolonged surgery (>5hours).
  DO NOT REPEAT GENTAMICIN WITHIN EIGHT HOURS OF INDUCTION DOSE
• Anaphylactic Penicillin allergy includes reactions to Cephalosporins, Carbapenems and any other Beta Lactams. Individuals with a DEFINITE history of ANAPHYLAXIS or URTICARIAL RASH immediately after being given a Penicillin, Cephalosporin or any other Beta Lactam antibiotic SHOULD NOT receive any of these antibiotics. If in doubt consult Microbiology or Pharmacy Medicines Information Department.
• NON URTICARIAL RASH allergy to Penicillins is unlikely to be associated with a serious cross reaction to Cephalosporins or Carbapenems. PENICILLINS should be avoided (further information)
• In the event of failed prophylaxis refer to TREATMENT guidelines for appropriate choice of antibiotic/s.

 

Procedures:

 

Breast Surgery

Gastrointestinal & Biliary Surgery

Hand Surgery

Obstetric & Gynaecological Surgery

Orthopaedic Surgery

Urological Surgery

Vascular Surgery

Splenectomy local guidelines (GHNHSFT intranet)