ANAESTHETISTS ROLE IN PREVENTION OF POSTOPERATIVE 2019-11-08¢  ANAESTHETISTS ROLE IN PREVENTION OF POSTOPERATIVE

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  • ANAESTHETISTS ROLE IN PREVENTION OF POSTOPERATIVE

    INFECTION Dr Alison Williams

    Anaesthetist, Canterbury and Concord Hospitals, SLHD

  • OUTLINE

    Evidence based strategies for prevention

    My issues in antibiotic prophylaxis

    Developing a guideline

    Future developments

  • HOW DO ANAESTHETIST PREVENT INFECTION

    The Perioperative Care of the Patient

    Pre-operatively

    Intra-operatively

    Post-operatively

  • EVOLVING EVIDENCE

    N Engl J Med 2018; 378:2263-2274DOI:10.1056/NEJMoa1801601

  • PREHABILITATION

    30minutes of physiotherapy education and breathing exercise coaching

    Halved Pulmonary Complications

    BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5916

    https://doi.org/10.1136/bmj.j5916

  • FOR EFFECTIVE PROPHYLAXIS

    THE MIC OF THE ANTIBIOTIC AGENT AT TISSUE

    LEVEL MUST BE EXCEEDED FOR AT LEAST THE

    PERIOD FROM INCISION TO WOUND CLOSURE

  • INDUCTION OF ANAESTHESIA & SURGERY START TIME

    0 10 20 30 40 50 60 70 80 90

    Induction to SST - Craniotomy

    Induction to SST - Spine

    Induction to SST - TKR

    Induction to SST -Breast

    Induction to SST - Lap Chole

    Induction to Tourniquet TKR

  • ITS IN THE TIME OUT? RIGHT?

    -60 -50 -40 -30 -20 -10 0 10 20 30

    Vancomycin

    Cephazolin

    KTS - TKR

    Tourniquet On

    Time in Minutes (0 = Anaesthesia Induction)

    Antibiotic Dosing Times

  • https://www.nationalauditprojects.org.uk/NAP6home

    https://www.nationalauditprojects.org.uk/NAP6home

  • AUDITING SURGICAL ANTIBIOTIC PROPHYLAXIS

    • WHY?

    • DRUG CHOICE

    • DRUG DOSE

    • REPEAT DOSING

    • ASSESSING TIMING IS DIFFICULT

  • MY EXPERIENCE IN DEVELOPING A GUIDELINE

    CONCORD HOSPITAL

    ADD

    OBSTETRICS

    TAKEAWAY

    EXCESS

    CANTERBURY HOSPITAL

  • WHERE NEXT

    Guidelines – I am happy to share

    Champions

    Engage Clinician Stakeholders

    Support Auditing

    Alison.Williams@health.nsw.gov.au