,SpB(K)BA
4
Kasus Usia
Ko-morbid
SDM
Cuci tangan SOP Antibiotik
5
MENGAPA PERLU PROFILAKSIS
Delayed healing
Hernia
Possible evisceration
Abscess
Fistula
Other procedures needed
8
Keuntungan dan Keterbatasan
penggunaan antibiotik profilaksis
1. Antibakteri, yang
digunakan untuk mencegah
komplikasi infeksi pada
tindakan operasi.
2. diberikan sebelum operasi,
ulangan saat operasi atau
setelah operasi
3. batasan waktu: tidak
melebihi 24 jam
INDIKASI
PROFILAKSIS
GOLONGAN OPERASI
• bersih
• bersih kontaminasi
• kontaminasi
• kotor
Surgical Site Infection / IDO
Definition
• superficial 30 hari
• deep 90 hari
• organ space 90 hari
• ortopedi 1 tahun
CDC 2017
kolonisasi
Antibiotika profilaksis
Profilaksis Dosis Tunggal v/s Multipel
Tidak
Fakta ada
laporan perbedaa
n
signifikan
• Antibiotik
– Cefazolin 2 g
– Cefuroxime 1,5 g
• i.v/drip dalam 100 ml NS,
selama 15 menit
• 30-60 menit sebelum insisi
• Tanpa test
• Di kamar operasi
BENANG MENGANDUNG ANTISEPTIK
QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE
CONDITIONAL MODERATE
The panel suggests the use of
triclosan-coated sutures for
the purpose of reducing the
risk of SSI, independent of the
type of surgery.
WHO, 2016
ANTISEPTIK KULIT
QUALITY
RECOMENDATION STRENGHT OF
EVIDENCE
recommends alcohol-based Strong Low to
antiseptic solutions based on moderate
Chlorhexidine Gluconate for
surgical site skin preparation in
patients undergoing surgical
procedures.
WHO, 2016
CUKUR VS KERIK
Elective
Clipping hair just before case is best
Surgical
Procedures Hair Removal Infection Rate
Hair Removal Method
sore / kerok/shaving 5.2 - 8.8%
pagi / kerok 6.4 - 10%
sore / cukur 4 - 7.5%
pagi / cukur 1.8 - 3.2%
QUALITY
STRENG
RECOMENDATION OF
HT
EVIDENCE
• patients undergoing any surgical Strong Moderate
procedure, hair should either not be
removed or, if absolutely necessary,
it should be removed only with a
clipper. Shaving is strongly
discouraged at all times, whether
preoperatively or in the OR.
WHO, 2016
ADVANCED DRESSINGS
QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE
WHO, 2016
ANTIMICROBIAL PROPHYLAXIS IN THE
PRESENCE OF A DRAIN AND OPTIMAL
TIMING FOR WOUND DRAIN REMOVAL
QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE
preoperative antibiotic prophylaxis CONDITIONAL LOW
should not be continued in the
presence of a wound drain for the purpose
of preventing SSI.
WHO, 2016
PEMANJANGAN PEMBERIAN
ANTIBIOTIK
QUALITY OF
RECOMENDATION STRENGHT
EVIDENCE
STRONG MODERATE
The panel recommends against
the prolongation of SAP after
completion of the operation for
the purpose of preventing SSI.
Moderate quality evidence from a high number of RCTs (44 studies included in the
overall meta- analysis) shows that prolonged SAP postoperatively has no benefit in
reducing SSI after surgery when compared to a single dose.
WHO, 2016
ANTIBIOTIC GUIDELINE FOR PROPHYLAXIS
JOHNS HOPKINS 2016
Evidence
Prosedure Antibiotic Odd.Rt
Level
Prosedur Sectio Cesarea HR 1 0.41
Operasi Histerektomi TAH / TVH
R 1 0.17
& Tonsilectomy NR 1
Antibiotik Luka pada wajah NR 1
profilaksis Partus normal + episiotomi
NR 1
Strumectomy NR 1 -
Ca Mammae R 1
Appendectomy HR 1 0.58
HR= High Recommended
R = Recommended Colorectal surgery HR 1
NR= Not Recomended
Hernia NR 1
TUR prostate HR 1
Arthroplasty HR 1
SIGN 2014 Pemasangan kateter NR 1
OPERASI TIDAK MEMERLUKAN ANTIBIOTIK
TERIMA KASIH
There Is No Way Home
KITA DAPAT MENCEGAH INFEKSI
TETAPI SULIT MENGHINDARI
RESISTENSI
32