Surgical wound infections: an overview.

There have been three major avenues by which control over infection has been increased: (1) Preservation of host defenses, (2) antisepsis and (3) asepsis. Despite the major successes we have had, infection remains the major limitor of surgical horizons. Asepsis, the newest but long the mainstay of infection control, has probably been developed to nearly its greatest capacity. Its forefronts lie in laminar flow ventilation, ultraviolet radiation and operating theater design, all expensive and relatively inefficient. Cost and the problem of endogenous bacteria limit further advances. Antisepsis, including preventive antibiotics, is also reaching its zenith. Resistant organisms, toxicity and cost limit further applications. We desperately need a "social contract" among surgeons to limit, by defined rules, the choice of agent, the total dose and the indications for use. Controlled studies of the effects of "preventive antibiotics" on hospital ecology and infection are needed. A return to antiseptics is being and should be explored. Preservation and enhancement of host defenses is the oldest but the most neglected of these ideas. It appears to be the most exploitable now. Enhancement by nutrition, maintenance of tissue perfusion, oxygenation and immune stimulation appear to have contributed to reduction of infection rates. More success in this area seems distinctly possible.