8/12/2019 ASHP Guidelines for S.a.P. (Surgical Antibiotic
Prophylaxis)
3/3
ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in
Surgery
3E.R. Reyes
Goals of Surgical Prophylaxis
1. Prevent postoperative infection of the surgical site
2. Prevent postoperative infectious morbidity and mortality
3. Reduce the duration and cost of health care
4. Produce no adverse effects
a. Have no adverse consequence for the microbial flora of
the
patient or the hospital
To achieve these, antimicrobials should be:
a. Active against the pathogens most likely to contaminate the
wound
b. Given in appropriate dosage and at a time that ensures
adequate
concentration at the incision site during the period of
potential
contamination
c. Safe and administered for the shortest effective period to
minimize
ADR, devt of resistance, and cost.
The modified National Research Council wound classification
criteria asfollow:
Clean Surgical Procedures
primary closed, elective procedures involving no acute
inflammation, no break in technique, and no tansection of
GI,
oropharyngeal, GU, biliary or tracheobronchial tracts
Clean-Contaminated Procedures
procedures involving transaction of GI, oropharyngeal, GU,
biliary,
or tracheobronchial tracts with minimal spillage or with
minor
breaks in technique
clean procedures performed emergently or with major breaks
in
technique
reoperation of clean surgery within seven days
procedures following blunt trauma
Contaminated Procedures
Clean-contaminated procedures during which acute,
nonpurulent
inflammation is encountered or major spillage or technique
break
occurs
Procedures performed within four hours of penetrating trauma
or
involving a chronic open wound
Dirty Procedures
Procedure performed when there is obvious pre-existing
infection
o Presence of abscess, pus, necrotic tissue
Preoperative perforation of GI, oropharyngeal, biliary, or
tracheobronchial tracts
Penetrating trauma greater than four hours old
NOTE:
I. Prophylactic antimicrobials are not indicated for clean
surgical
proceduresa. Only justified for procedures involving prosthetic
placement
because of the potential for severe complications if
postoperative infections involve the prosthesis
II. The use of antimicrobials for dirty and contaminated
procedures is
not classified as prophylaxis but as treatment for a
presumed
infection
