SUGGESTED PRACTICE IN UNDER-RESOURCED SETTINGS With the exception of ophthalmic procedures, topical administration of antibiotics as prophylaxis, based on their lack of efficacy and the possibility of adverse reactions, is not recommended.In laparoscopic biliary tract procedures since some factors increasing the risk for SSI cannot be determined before the procedure (e.g., gallbladder empyema, perforation or infection, prolongation of procedure >60 minutes), it may be reasonable to give a single dose of antimicrobial prophylaxis to all patients.The redosing interval should be measured from the time of administration of the preoperative dose, not from the beginning of the procedure. In the case of excessive blood loss (>1,5 Lt), or whenever the duration of operation exceeds 2 half-lives of the preadministered antibiotic(s), intraoperative redosing should be given.Because of prolonged infusion time required for vancomycin (1h) it should be administered within 120 min before surgical incision. Decreasing the risk of surgical site infections (SSIs) and strongly recommended are: a preoperative shower, decolonization of patients with known nasal carriage of Staphylococcus aureus (especially in cardiothoracic and orthopaedic surgery), avoiding hair removal or, if this is absolutely necessary, removal with a clipper, surgical site skin preparation with alcohol-based antiseptics in the operating room, a single preoperative dose of a first- or second-generation cephalosporin within 120 minutes before incision (considering the half-time of the antibiotic) and intraoperative organ support with normothermia, hyperoxygenation, and intensive blood glucose control (15-20%) as well as in beta-lactam allergic patients. New guidelines have been issued by WHO (2016) and CDC (2017). Appropriate organ function support, skin preparation, antimicrobial prophylaxis and wound care, decrease the incidence of both incisional and deep infections (organ or space) after certain operations.Prevention requires measures before, during, and after surgery. Surgical site infections (SSIs) are preventable and epidemiologically important, affecting up to one third of patients who had surgery in low- and middle-income countries 1-8and being the second most common healthcare-associated infection in Europe and the USA.
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