RRL 1 Wound infections are the most common hospital acquired infections in surgical patients.

It is one of the oldest known problems after trauma and amputation. A study about surgical prophylaxis was done by Raheer Anjum et. Al (2011). The researchers aimed to prove if surgical prophylaxis is necessary in clean surgical operations. A total of 120 surgical patients were randomly selected and grouped into two equal groups, namely group A and group B. Patients in group A were given Cefuroxime 750mg intravenously 30 minutes before the operation and continued for first 24 hours postsurgery at an eighthour interval while patients in group B were not given any prophylactic drug. Results were gathered and found out that 1 out of 60 patients in group A while 3 out of 60 patients in group B developed surgical site infections. These results were analyzed using Chi Square Test and have proven that there is no significant difference between the two. The researchers conducted that preoperative antibiotic prophylaxis does not significantly reduce the frequency of postoperative wound infection in clean elective general surgical operations so the routine prophylaxis is not recommended.

Source: Antibiotic Prophylaxis Is It Necessary In Clean General Surgery? Raheel Anjum, Muhammad Parvez Pakistan Armed Forces Medical Journal, September 2011, Issue No. 3 http://www.pafmj.org/showdetails.php?id=476&t=o

RRL 2 According to the research conducted by Bratzler et al. there are several factors that contribute to the success of surgical prophylaxes; preoperative dose timing, selection and dosing and duration of prophylaxis. The optimal time for administration of preoperative dose of antibiotic is within 60 minutes before the surgical incision and some agents such as fluoroquinolones and vancomycin require preoperative dose administration of one to two hours. Selection and dosing is another factor since previous studies have shown that obesity has been linked to an increased risk for surgical site infections

so dosage adjustments based on body weight may be warranted, while the duration of prophylactic administration involves a single dose or continuation for less than 24 hours postsugery. Other factors such as attention to the basic infection control strategies, surgeons experience and technique, duration of procedure, hospital and operating room environment, instrument sterilization issues, preoperative preparation, perioperative management, and the patients underlying medical condition also contribute to the success of the surgical prophylaxis. Antimicrobial prophylaxis may be of benefit in surgeries associated with high risk of infections and in certain clean procedures where there are severe consequence of infection, even unlikely, however, antimicrobial prophylaxis is not indicated for some clean surgical procedures and an available data suggest that the relative risk reduction of surgical site infection with prophylaxis is the same in both clean and high risk procedures. The decision depends on the cost, as well as the morbidity associated with infection compared with the cost and morbidity associated with using the prophylaxis.

Source: Clinical Practice Guidelines For Antimicrobial Prophylaxis In Surgery Bratzler, Dale et al. American Journal of Health System Pharmacy, February 1, 2013, pp. 195-283 http://www.ajhp.org/content/70/3/195

RRL 3 According to Bao et al. some clean surgical operations like surface procedures in the head and neck, trunk, limbs, and clean operations like inguinal herniotomy and fibroadenoma in the breast, etc. do not recommend the use of surgical prophylaxis. When the clean procedures last for a long time, and massively invasive and/or the patient is at high risk for developing an infection, surgical prophylaxis is recommended. In their study, there were 1181 male and 819 female with a mean age of 47 years old are used as subject. All patients received prescribed prophylactic antibiotics and most frequently used were Cephalosporins (94.15%). Prophylactic antibiotics were administered at 30 minutes to 2 hours before

surgery in 1204 of the patients while at more than 2 hours before surgery in 452 of the patients, before and during the surgery in 19 patients and after surgery in 325 patients. Results were gathered and found out that only 45 patients developed the postoperative infection, indications of which were unclear. The researchers concluded that proper application of antibiotic prophylaxis can prevent postoperative infection and promote recovery and improper application may cause drug resistance and unwanted damage to the patients.

Source: Prophylactic Use Of Antibiotics For Clean Operative Procedures Lidao Bao et al African Journal of Pharmacy and Pharmacology, Vol. 5, November 15, 2011, pp. 2062-2066 http://www.academicjournals.org/ajpp/pdf/pdf2011/15%20November/Bao%20et%20al.pdf