Prevention, diagnosis, and treatment of postoperative infections.

Discontinuation of routine use of plastic surgical adhesive drapes, the electrocautery surgical knife, routine preoperative shaving, and routine intraoperative placement of wound drains may reduce the incidence of postoperative wound infection. Other potentially helpful measures include hot conization of the cervix before hysterectomy, delayed wound closure, and minimization of preoperative hospitalization time. Microbiologic cultures and the standard temperature definition of morbidity help but little in diagnosing postoperative infection; needed is careful physical examination of the patient before antibiotics are given. Drainage of abscesses and delay of wound closure may help one avoid the use of antibiotics. To prevent infections, an appropriate antibiotic should be in the tissues within 3 hours after surgery; its use should end in the recovery room. Prospective comparison studies are needed to help physicians choose among today's antibiotics.