Practice development


and patients were instructed not to shave themselves preoperatively. All razors were removed from operating


rooms and the team worked with the purchasing department to provide a continuous supply of clippers.


Page points


1. Surgeons, pharmacists and the infection control team


were all involved in developing a standardised prophylactic antibiotic guideline


2. Where surgery was scheduled to last for more than four hours or where the estimated blood loss was expected


to exceed one litre, a repeat dose of antibiotics was administered


Prophylactic antibiotic regimen Surgeons, pharmacists and the infection control team were all involved in developing a standardised prophylactic antibiotic guideline that was consistent


with international recommendations[4, 5]


. The guideline specifically stated


that antibiotics must be administrated within 30 minutes of a surgical incision as per the recognised evidence-based practice for SSI prevention[6]


encourage compliance. Notices, proforma, checklists and posters describing the prophylactic antibiotic guideline were used as reminders. The proforma and checklists served to prompt clinicians and track their compliance to the protocol as they signed off when action was taken. The antibiotic dosage was adjusted according to the patient’s body weight. Medications were stocked in the hospital according to the standard drugs inventory.


. Classen et al


convincingly demonstrated that the SSI rate is at its lowest point when antimicrobial prophylaxis is administered within the first hour of anaesthesia induction [6]


. Where surgery was scheduled to last for more


than four hours or where the estimated blood loss was expected to exceed one litre, a repeat dose of antibiotics was administered as extensive blood loss can dilute the prophylactic antibiotics serum concentration and impair immunity. The guideline was circulated to all


operating room staff and anaesthetists to References


4. American Society of Health- system Pharmacists [ASHP]


Commission on Therapeutics. ASHP therapeutic guidelines


on antimicrobial prophylaxis in surgery. Clin Pharm 1992, 11(6): 483–513.


5.Waddell TK, Rotstein OD: Antimicrobial prophylaxis in surgery. Committee on


Antimicrobial Agents, Canadian


Infectious Disease Society. CMAJ 1994, 151(7): 925–31.


6. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992, 326(5): 281–6.


7.Melling A, Ali B, Scott E, Leaper D. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet 2001; 358(9285): 876–880.


Postoperative core temperature monitoring A target of keeping patients’ postoperative core body temperature within the range of 36–38°C was set. Maintaining normothermia has many benefits and has been shown to reduce the risk of complications and cost. Perioperative unplanned hypothermia is a


Routine glucose monitoring A mandatory glucose monitoring regimen was introduced for diabetic patients. Post Anaesthesia Care Unit (PACU) and ward nursing officers were responsible for monitoring and controlling diabetic patients’ postoperative blood glucose levels at six- hourly intervals to ensure that they were kept below 11.1mmol/l.


Figure 1 – The authors’ team performing surgery in the operating room.


11


Wounds International Vol 2 | Issue 1 | ©Wounds International 2011


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61