A national audit of antibiotic prophylaxis in elective laparoscopic cholecystectomy.

INTRODUCTION: Laparoscopic surgeons in Great Britain and Ireland were surveyed to assess their use of antibiotic prophylaxis in elective laparoscopic cholecystectomy. This followed a Cochrane review that found no evidence to support the use of antibiotic prophylaxis in routine cases. METHODS: Data were collected on routine use of antibiotics in elective laparoscopic cholecystectomy, and how that was influenced by factors such as bile spillage, patient co-morbidities and surgeons' experience. An online questionnaire was sent to 450 laparoscopic surgeons in December 2011. RESULTS: Data were received from 111 surgeons (87 consultants) representing over 7,000 cases per year. In routine cases without bile spillage, 64% of respondents gave no antibiotics and 36% gave a single dose. In cases with bile spillage, 11% gave no antibiotics. However, 80% gave one dose and 7% gave three doses. Co-amoxiclav was used by 75% of surgeons. Surgeons are more likely to give antibiotics when patients have risk factors for infective endocarditis. CONCLUSIONS: This study suggests over 20,000 doses of antibiotics and over £100,000 could be saved annually if surgeons modified their practice to follow current guidelines.

Sterilization of oils: Data to support the use of a continuous point-of-use sterilizer.

The continuous slow feed of animal and vegetable oils is frequently found to be an economically attractive method for maintaining antibiotic fermentations at a highly productive rate. The sterilization of oil feeds can present a major problem in the production plant. In this article, we present data and methodology on the kinetics of the thermal sterilization of No. 2 lard oil and soybean oil. It was also determined that dry heat sterilization condition could occur if dry spores were added to dry oil. This condition could only be partially alleviated by the addition of water to the oil. The theory and design of a small tubular coil continuous sterilizer for sterilizing oils at the point of use is also presented. This type of sterilizer is economical and versatile and simplifies control and instrument requirements. It provides a realistic alternative to the use of sterile feed tanks and sterile headers.