A protocol for the treatment of severe infections of the hand.

A protocol for the treatment of hand infections was used for 69 patients in a university teaching hospital. The protocol prescribes incision and drainage under optimal conditions (in the operating room) when the patient is first seen and intravenous antibacterial therapy effective against anaerobic and aerobic bacteria initiated immediately after obtaining aerobic and anaerobic cultures. Results of bacteria studies confirmed the significant frequency (nearly 30%) of mixed aerobic and anaerobic infection. Use of the protocol resulted in a shorter hospital stay, faster healing, and fewer complications (recrudescence of infection, reoperation, stiffness, arthritis, and osteomyelitis) when compared with 107 patients who were treated before institution of the protocol.