ROJoson PEP Talk: Do ALL Operations Need Antibiotics?

ROJoson PEP Talk: Do ALL Operations Need Antibiotics?

1. August 30, 2025 1400H - 1500H Via Zoom Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management.

2. Augsut 30, 2025 1400H - 1500H Via Zoom Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management. Welcome all! MUTE yourself but always show your video picture. Sign in your name, FB account, or email address in the Chat Box! Include names of companions attending. Use the Chat Box to ask questions and make comments while the PEP TALK is on. There will be group pictures at start and end of PEP TALK – show your face in video.

3. t Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

4. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

5. Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

6. Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START PEP TALK PROPER IN 2 MINUTES! Pls. turn on your video! Show your face!

7. Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management. ROJoson PEP Talk I have a Patient Empowerment Program in which I like to empower the lay people or patients to take control in the management of their health.

8. I started the PEP Talk on May 15, 2021 during the COVID19 Pandemic. There are 3 courses in the PEP Talk. I completed the Core Course on October 9, 2021.

9. From October 23, 2021 onwards, I have been tackling Health Disorder and Health Issue Courses. May 17, 2025 marks the start of YEAR 5 of ROJoson PEP Talk. How long the PEP Talk will last will depend on our enthusiasm , discipline and perseverance .

10. Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management. My PEP TALK today is entitled: Do ALL Operations Need Antibiotics?

11. Contents Do ALL operations need antibiotics? What are the indications for antibiotics in operations? What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Disclaimer: ROJoson PEP Talk contains ROJoson’s Thoughts, Perceptions, Opinions and Recommendations (TPORs) culled from experiences of ROJoson and writings of other health professionals. Do ALL Operations Need Antibiotics?

12. Do ALL operations need antibiotics? NO, NOT ALL operations need antibiotics. NO, NOT ALL operations need antibiotics. NO, NOT ALL OPERATIONS NEED ANTIBIOTICS. There is a common perception among laypeople and even health professionals who are NOT surgeons that ALL operations need antibiotics. SADLY, there are also some surgeons who perceive need for antibiotics in all their operations and therefore, give to all. Do ALL Operations Need Antibiotics?

13. i What are the indications for antibiotics in operations? Primary guide on the indications for giving antibiotics in operations is the assessment by the surgeon on the risk of infection after the operation, whether LOW, INTERMEDIATE, HIGH or VERY HIGH risk. Thus, when antibiotics are given during operation, the objective is to prevent postoperative infection. Do ALL Operations Need Antibiotics?

14. i What are the indications for antibiotics in operations? The risk of postoperative infection (LOW, INTERMEDIATE, HIGH or VERY HIGH) is based on several factors: Resultant surgical or operative wound classification Type of surgery Operative factors Patient factors Do ALL Operations Need Antibiotics?

15. i Do ALL Operations Need Antibiotics? Resultant surgical or operative wound classification - RISK FACTOR Resultant Surgical Wound Classification Definition Infection Risk CLEAN No infection, no entry into respiratory, gastrointestinal, genitourinary tracts LOW CLEAN-CONTAMINATED Entry into GI, GU, or respiratory tracts under control INTERMEDIATE CONTAMINATED Open wounds, gross spillage, break in sterile technique HIGH DIRTY / INFECTED Existing infection or perforated viscera VERY HIGH

16. i Do ALL Operations Need Antibiotics? Resultant surgical or operative wound classification - RISK FACTOR Resultant Surgical Wound Classification Definition Infection Risk Indications for Antibiotics CLEAN No infection, no entry into respiratory, GI, GU tracts LOW CLEAN-CONTAMINATED Entry into GI, GU, or respiratory tracts under control INTERMEDIATE CONTAMINATED Open wounds, gross spillage, break in sterile technique HIGH DIRTY / INFECTED Existing infection or perforated viscera VERY HIGH

17. i Type of Surgery - RISK FACTOR Do ALL Operations Need Antibiotics? Surgery Type Risk Level Indications for Antibiotics Superficial skin lesion excision Low Elective hernia repair Low to Intermediate Colon resection High Emergency abdominal surgery (e.g. perforation) Very High Joint replacement, cardiac surgery High (due to implants)

18. i OPERATIVE RISK FACTORS Do ALL Operations Need Antibiotics? Operative Condition Effect Indications for Antibiotics Long operative time Increased risk Breaks in sterility Increased risk Use of prosthetic material Increased risk

19. i PATIENT RISK FACTORS Do ALL Operations Need Antibiotics? Operative Condition Effect Indications for Antibiotics Diabetes, immunosuppression Increased risk Obesity, smoking, poor nutrition Increased risk Age > 70 Increased risk Preexisting infection Increased risk

20. i Example Summary of Risk Levels: (consider wound type; surgery type; operative factors and patient factors together) Do ALL Operations Need Antibiotics? Conditions and Situations Risk Level Indications for Antibiotics Clean surgery, healthy patient, <2h duration, no prosthesis LOW Clean-contaminated, longer surgery, minor comorbidities INTERMEDIATE Contaminated or dirty surgery, immunocompromised patient HIGH

21. i Among the 4 factors to consider in the risk assessment for postoperative wound infection: Resultant surgical or operative wound classification (GREATEST WEIGHT) [clean; clean-contaminated; contaminated; dirty/infected] Type of surgery Operative factors Patient factors Do ALL Operations Need Antibiotics?

22. i Antibiotics, if indicated, can be administered preoperatively and continued postoperatively; preoperatively only; and postoperatively only. Antibiotics can be injectable or in the form of pills (tablets or capsules). The surgeons decide on the most COST-EFFECTIVE REGIMEN. Do ALL Operations Need Antibiotics?

23. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? NOT ALL OPERATIONS NEED ANTIBIOTICS. We have to emphasize this to the laypeople, non-surgeon healthcare professionals and some surgeons who think all patients undergoing any type of operation need antibiotics. To correct their misperceptions; to modulate patients’ expectation and request for antibiotics; and to modulate surgeons’ unnecessary prescription of antibiotics in operations. Do ALL Operations Need Antibiotics?

24. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Antibiotics should be given only if indicated. Laypeople should remember these general guidelines: LOW RISK for postoperative infection – NOT NEEDED. HIGH RISK – INDICATED. INTERMEDIATE RISK – let the surgeon decide. Do ALL Operations Need Antibiotics?

25. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Antibiotics should be given only if indicated. LOW RISK for postoperative infection – NOT NEEDED. HIGH RISK – INDICATED. INTERMEDIATE RISK – let the surgeon decide. Laypeople should know that giving antibiotics do not guarantee zero postoperative infection. There are other factors to consider. Surgeons decide based on COST-EFFECTIVENESS. Do ALL Operations Need Antibiotics?

26. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Antibiotics should be given only if indicated. LOW RISK for postoperative infection – NOT NEEDED. HIGH RISK – INDICATED. INTERMEDIATE RISK – let the surgeon decide. Laypeople should know that NOT giving antibiotics guarantees zero postoperative infection. Infection rate is usually LOW. Surgeons decide based on COST-EFFECTIVENESS. Do ALL Operations Need Antibiotics?

27. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Antibiotics should be given only if indicated. LOW RISK for postoperative infection – NOT NEEDED. HIGH RISK – INDICATED. INTERMEDIATE RISK – let the surgeon decide. The surgeons should always explain to the patients why they will and why they will NOT prescribe antibiotics and get an informed consent on this from the patients. Do ALL Operations Need Antibiotics?

28. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Antibiotics should be given only if indicated. LOW RISK for postoperative infection – NOT NEEDED. HIGH RISK – INDICATED. INTERMEDIATE RISK – let the surgeon decide. The patients should ask their surgeons whether antibiotics are needed or not and why. Do ALL Operations Need Antibiotics?

29. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Antibiotics should be given only if indicated. LOW RISK for postoperative infection – NOT NEEDED. HIGH RISK – INDICATED. INTERMEDIATE RISK – let the surgeon decide. The patients should look for MINIMALIST surgeons (prescribing only when needed) rather than RITUALISTIC (de cahon with no rationalization) and MAXIMALIST surgeons (with better to overdo stance). Do ALL Operations Need Antibiotics?

30. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Why is judicious use of antibiotics important? Overuse and misuse of antibiotics contribute significantly to the development of antibiotic-resistant bacteria ("superbugs"), which are a major global health threat. Therefore, healthcare providers follow strict guidelines to ensure antibiotics are used only when truly necessary to maximize their effectiveness and minimize the risk of resistance. Do ALL Operations Need Antibiotics?

31. i What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations? Why is judicious use of antibiotics important? Also, use of antibiotics has both benefit (control of infection) and risks (side effects), not just benefits. Also, use of antibiotics entails cost. Antibiotics are usually expensive. Do ALL Operations Need Antibiotics?

32. Summary Take Away Do ALL Operations Need Antibiotics? Contents Do ALL operations need antibiotics? What are the indications for antibiotics in operations? What are ROJoson Advocacy Positions on the use and non-use of antibiotics in operations?

33. Take Away in relation to Patient Empowerment Be always in touch with reliable medical information on “ Do ALL Operations Need Antibiotics”. Knowledge is power; it gives power. Use the 4Ks of Patient Empowerment: Kaalaman , Kakayanan , Karapatan and Kapangyarihan to gain greater control over decisions / make better decisions on “ Do ALL Operations Need Antibiotics” as part of your health management. Do ALL Operations Need Antibiotics?

34. Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management. This ends my PEP TALK today on: Do ALL Operations Need Antibiotics?

35. t Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

36. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

37. Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

38. Do ALL Operations Need Antibiotics? Empowerment objective - for laypeople to have an essential  understanding on whether all operations need antibiotics as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START Q&A AND INTERACTIONS! Pls. turn on your video! Show your face!