Tjasa Hranjec1, Brian R Swenson, Robert G Sawyer. 1. Division of Trauma and Surgical Critical Care, Department of Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
Abstract
BACKGROUND: Efforts to prevent surgical site infection (SSI) employ methods that are valid scientifically, but each institution and each surgeon also incorporates methods believed to be useful although this has not been proved by clinical trials. METHODS: The surgical literature was reviewed, as were practices at the University of Virginia that the authors believe are of value for the prevention of SSI. RESULTS: Preventive antibiotics are established measures. A case can be made for increasing the dose in patients with a large body mass, and antibiotics probably should be re-administered during procedures lasting longer than 3 h. Chlorhexidine showers for the patient are not proven; however, they are inexpensive and of potential benefit. Hair removal is always done with clippers and in the operating room at the time of the procedure. No scientific case can be made specifically for using antiseptic at the surgical site before the incision. Keeping the blood glucose concentration and the core body temperature near normal probably are important, but how close to normal is unclear. Transfusion enhances SSI, but leukocyte reduction of transfused blood may be of benefit. Some evidence supports the value of antibacterial suture in preventing SSI. CONCLUSIONS: Many proven and potentially valid methods are employed to prevent SSI. Coordinated and standardized protocols with good data collection can assist the multi-disciplinary efforts to reduce SSI within the unique practices of a given institution.
BACKGROUND: Efforts to prevent surgical site infection (SSI) employ methods that are valid scientifically, but each institution and each surgeon also incorporates methods believed to be useful although this has not been proved by clinical trials. METHODS: The surgical literature was reviewed, as were practices at the University of Virginia that the authors believe are of value for the prevention of SSI. RESULTS: Preventive antibiotics are established measures. A case can be made for increasing the dose in patients with a large body mass, and antibiotics probably should be re-administered during procedures lasting longer than 3 h. Chlorhexidine showers for the patient are not proven; however, they are inexpensive and of potential benefit. Hair removal is always done with clippers and in the operating room at the time of the procedure. No scientific case can be made specifically for using antiseptic at the surgical site before the incision. Keeping the blood glucose concentration and the core body temperature near normal probably are important, but how close to normal is unclear. Transfusion enhances SSI, but leukocyte reduction of transfused blood may be of benefit. Some evidence supports the value of antibacterial suture in preventing SSI. CONCLUSIONS: Many proven and potentially valid methods are employed to prevent SSI. Coordinated and standardized protocols with good data collection can assist the multi-disciplinary efforts to reduce SSI within the unique practices of a given institution.
Authors: E Patchen Dellinger; Susan M Hausmann; Dale W Bratzler; Rosa M Johnson; Donna M Daniel; Kathryn M Bunt; Greg A Baumgardner; Jonathan R Sugarman Journal: Am J Surg Date: 2005-07 Impact factor: 2.565
Authors: R Finkelstein; G Rabino; T Mashiah; Y Bar-El; Z Adler; V Kertzman; O Cohen; S Milo Journal: J Thorac Cardiovasc Surg Date: 2002-02 Impact factor: 5.209
Authors: John J Engemann; Yehuda Carmeli; Sara E Cosgrove; Vance G Fowler; Melissa Z Bronstein; Sharon L Trivette; Jane P Briggs; Daniel J Sexton; Keith S Kaye Journal: Clin Infect Dis Date: 2003-02-07 Impact factor: 9.079
Authors: Traci L Hedrick; James A Heckman; Robert L Smith; Robert G Sawyer; Charles M Friel; Eugene F Foley Journal: J Am Coll Surg Date: 2007-09 Impact factor: 6.113
Authors: Brian R Swenson; Traci L Hedrick; Rosemarie Metzger; Hugo Bonatti; Timothy L Pruett; Robert G Sawyer Journal: Infect Control Hosp Epidemiol Date: 2009-10 Impact factor: 3.254
Authors: Shixuan Chen; Liangpeng Ge; Aubrey Mueller; Mark A Carlson; Matthew J Teusink; Franklin D Shuler; Jingwei Xie Journal: Nanomedicine Date: 2017-02-06 Impact factor: 5.307
Authors: Deverick J Anderson; Kelly Podgorny; Sandra I Berríos-Torres; Dale W Bratzler; E Patchen Dellinger; Linda Greene; Ann-Christine Nyquist; Lisa Saiman; Deborah S Yokoe; Lisa L Maragakis; Keith S Kaye Journal: Infect Control Hosp Epidemiol Date: 2014-06 Impact factor: 3.254
Authors: Shixuan Chen; Liangpeng Ge; Adrian F Gombart; Franklin D Shuler; Mark A Carlson; Debra A Reilly; Jingwei Xie Journal: Nanomedicine (Lond) Date: 2017-09-29 Impact factor: 5.307
Authors: A Obermeier; J Schneider; P Föhr; S Wehner; K-D Kühn; A Stemberger; M Schieker; R Burgkart Journal: BMC Microbiol Date: 2015-09-24 Impact factor: 3.605