Q: What is the role of antibiotic stewardship in post-operative wound healing for patients of sub-acute and long-term care facilities? 

A: Literature and research supports the use of antibiotics when deemed appropriate, though unnecessary use can lead to antibiotic resistance and development of MRSA and VRE. Where  does one draw the line in post-surgical wound care for older adults when the risk of infection is higher,  compared to younger individuals with fewer comorbidities?

The situation can be more complex when leaders are striving to maintain Quality Assurance and Performance Improvement standards for antibiotic usage.

It’s critical to understand each patient’s individual infection risks. 

Factors that predispose a person to develop infection include patient characteristics such as uncontrolled diabetes, smoking status, excessive deposition of adipose tissue, and autoimmune disorders that can lead to immune deficiency. Pre-operative risk factors also can factor in, such as when a patient with uncontrolled diabetes or hypertension needs an emergency hip replacement.

Then there is a suboptimal aseptic environment caused by  improper hand hygiene or skin preparation prior to the surgery. Post surgical risk factors may involve all of the above and the inability to mobilize early, excessive moisture or dryness, improper wound care and the inability to differentiate between inflammation during the healing process and development of infection.

Standards of care practices guide us toward initiation of the antibiotics when appropriate with the duration of the therapy.

Key factors for early detection and prompt intervention are to know your patient as a person, and to assess and examine them and their wounds at the time of admission. Timely follow-up with accurate documentation is doing the right thing at the right time.