Abstract

June 2008

Section Section 1 Basic Surgical and Perioperative Considerations

Surgical site infections (SSIs) continue to be prevalent and continue to exact a clinical and financial toll. The three determinants of infection: bacteria, local environment, and systemic host defenses are described; the factors that are under the surgeon's control such as OR hygiene practices, choice of drains, and use of electrocautery are listed; the host factors such as local blood flow, advanced age, shock, and smoking are described; sources of bacteria (endogenous and exogenous) and their properties are described; an algorithm for effective use of antibiotic prophylaxis is given. Five figures are presented, showing the determinants of any infectious process intersecting at a point indicating zero probability of sepsis; the three categories of SSIs; the wound infection rate in three different situations; the results of animals exposed to hemorrhagic shock followed by resuscitation and their decreased resistance to wound infection; the diameter of lesions inducted by staphylococcal inoculation. Eight tables detail the National Research Council classification of operative wounds, the parenteral antibiotics recommended for prophylaxis of surgical site infection, the conditions and procedures that require antibiotic prophylaxis against endocarditis, the antibiotics for prevention of endocarditis, the effect of surveillance and feedback on wound infection rates in two hospitals, the determinants of infection and factors that influence wound infection rates, quality improvement objectives to reduce surgical site infections, and the characteristics of three topical antimicrobial agents effective against both gram-positive and gram-negative bacteria. This chapter has 125 references. This chapter contains 118 references.

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