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http://lists.burnet.edu.au/listinfo/asid-ozbugMichael Wishart
Infection Control Coordinator
St Vincent's Private Hospital Northside & St Vincent's Private Hospital Brisbane
Brisbane, QLD
michael.wishart@svha.org.auHi Trent, have seen this being done for SSI (similar issue as you have found – being done by orthopods based on a very small study). But not seen it done peri operatively. And not in Antibiotic Guidelines to the best of my knowledge as a method of perioperative prophylaxis. And based on my experience with the interosseous AB given for SSI – yes you will probably get pushback from the orthopods. They should certainly be recording it on the drug chart.
Cheers
Fiona Wilson I Clinical Nurse Consultant
Public Health Services I Department of Health and Human Services
3/25Argyle St Hobart, GPO Box 125 Hobart 7001
Phone (03) 6166 0601| Mobile 0439 014 634 | Fax (03) 6233 0553
Prevention is better than cure[Cross-posted from Oz-Bug with permission – Moderator. Copies of replies will be forwarded to Dr Yarwood.]
Hi all,
Our hard-working infection control team have come to us with an interesting issue. It at first glance seemed that some of our joint replacements weren’t being given prophylactic antibiotics. A bit of digging found out that they were, it just wasn’t being recorded.
The problem is that the orthopaedic surgeons are giving the antibiotics intra-osseously, without any systemic prophylaxis (given pre-incision, after tourniquet insertion), seemingly based on this study: http://dx.doi.org/10.1007/s11999-012-2469-2
I’ll be talking to the surgeons about this soon. My initial impressions are:
* Small study
* No clinical endpoints
* Some questions about the methods (confusion of ug/g vs ug/mL of fat or bone)
* Is a fat concentration of 175mg/g 2 minutes after completion of infusion biologically plausible (ie: could they be measuring extravasated infusion solution rather than tissue concentrations)
* What impact could there have been of rinsing the tissues in saline prior to sending them off for analysis in terms of outcomes?
In short, there’s lots of issues and I’m not terribly keen in the absence of some clinical outcome data. I expect there’ll be some pushback from our orthopods, though.
Has anyone else seen this in your hospitals?—
Trent Yarwood
Infectious Diseases Physician, Cairns
trentyarwood@gmail.com________________________________
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