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Clean Vs. Contaminated Surgery

Plan for and prevent contamination with this antibiotherapy checklist.

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Confused by the amount of contamination to expect during your patient’s surgery? The table below is a good start to help you predict contamination and refine your antibiotherapy:

• Which type (s) of antibiotics?
• What dosage?
• How often?
• For how long?

Granted, such antibiotics should be based on a culture and sensitivity, but until those results are in, empiric antibiotherapy is in order.

This surgery classification is derived from the wound classification created by the National Research Council in humans. It is based on the level of expected bacterial contamination.

Surgery 
Classification
     

Description       Examples                      
Clean Typically an elective surgery in a non-contaminated, non-traumatic and non-inflamed surgical site

    -Neuter
    -"Routine" laparotomy
    -Elective orthopedic surgery

Clean contaminated Here surgery involves the respiratory, GI or genitourinary system, ie often a hollow organ

    -Enterotomy
    -Enterectomy
    -Cystotomy

Contaminated Similar surgeries, but with leakage or a major break in aseptic technique

    -Enterotomy
    -Enterectomy
    -Cholecystectomy
    -Cystotomy

Dry A hollow organ is ruptured  

    -Infected surgical site
    -Septic peritonitis
    -Abscess
    -Ruptured GI, gallbladder or pyometra

The need for antibiotics in clean wounds is somewhat controversial.  Most authors seem to agree that antibiotics should be used when:

• A clean surgery lasts more than 90 minutes.
• An implant is placed.
• An infection would have disastrous consequences.  The classic example is a total hip replacement.

In contaminated and dirty wounds, longer antibiotherapy or a combination of antibiotics may be necessary. Beyond antibiotics, never underestimate the power of lavage. After a bowel rupture, or a ruptured pyometra, rincing the abdominal cavity with 10 liters of sterile, warm saline is not unusual in our practice.

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