Pre-op oral antibiotics prior to elective colorectal surgery (Antimicrobial)

Post-operative surgical site infection (SSI) after colorectal surgery causes significant morbidity and mortality. Due to concerns over such infections, the NHS Highland Colorectal SSI Quality Improvement Group was formed in late 2011. Infection control surveillance of post-operative infections showed variation in practice in a number of areas including skin closure, on time antibiotic prophylaxis, peri-operative temperature and blood glucose levels and post-operative wound dressing management.  Since the constitution of the group and the standardisation of pre, peri and post-operative management, the SSI rate has reduced by one third.  In 2016, the World Health Organisation published guidelines to reduce SSI after surgery.  The document contains 9 strong and 21 conditional recommendations specific to colorectal surgery.  NHS Highland Colorectal SSI Quality Improvement Group has considered each of the recommendations within the guidelines in turn with the majority being adopted or already in place.  Antibiotic use around the time of surgery is restricted to intravenous prophylaxis given in the 60 minutes prior to skin incision for a single dose unless the procedure last more than four hours or there is blood loss above 1500mL, in line with WHO and NICE Guidelines 125.

Note.  In April 2021, neomycin 500mg tablets were discontinued in the UK.  A source of unlicensed tablets has been obtained and this information has been added to the prescription form to highlight to the prescriber.

For glossary of terms see Glossary.