2005 WebMD, Inc. All rights reserved.

I BASIC SURGICAL AND PERIOPERATIVE CONSIDERATIONS 2

ACS Surgery: Principles and Practice

PREVENTION OF POSTOPERATIVE INFECTION 2

Epidemiology of Surgical Site Infection

Surgical site infection is caused by exogenous or endogenous bacteria; infection is influenced not only by the source of the infecting inoculum but also by the bacterial characteristics.

Ensure that prophylactic antibiotics, if indicated, are present in tissue in adequate concentrations at beginning of operation.

Endogenous factors or sources of bacteria

Bacterial characteristics of importance (virulence and antibiotic resistance)

Exogenous factors or sources of bacteria

Remote sites of infection Postpone elective operation if possible. Treat remote infection appropriately.

Skin

Bowel

Nature and site of operation Is the operation Clean Cleancontaminated Contaminated Dirty or infected

Size of inoculum required to produce infection Varies in different clinical situations.

Operating teamrelated Comportment Use of impermeable drapes and gowns Surgical scrub

Operating roomrelated Traffic control Cleaning Air

Surveillance and quality assurance

Preventive measures to control bacteria Decontamination of patient's skin [see Sidebar Preoperative Preparation of the Operative Site] Additional antibiotics if indicated, depending on likelihood of contamination and on bacterial inoculum and properties [see Sidebar Antibiotic Prophylaxis of Infection]

 2005 WebMD, Inc. All rights reserved.

I BASIC SURGICAL AND PERIOPERATIVE CONSIDERATIONS 2

ACS Surgery: Principles and Practice

PREVENTION OF POSTOPERATIVE INFECTION 3

BACTERIA

HOST DEFENSE MECHANISMS Factors contributing to dysfunction of host defense mechanisms can be related to surgical disease, to events surrounding the operation, to the patients underlying disease, and to anesthetic management.

SURGICAL SITE Surgeon-related Factors influenced by the surgeon include Preoperative decisions Timing of operation Surgical technique Transfusion Blood loss Duration and extent of operation Glucose control Tissue oxygenation (mask)

Patient-related Patient-related factors include Presence of 3 concomitant diagnoses Underlying disease Age Drug use Preoperative nutritional status Smoking

Anesthesiologist-related Normothermia Normovolemia Pain control Tissue oxygenation Glucose control Sterility of drugs

Surveillance and quality assurance

Local factors influence the susceptibility of the wound environment by affecting the size of the inoculum required to produce infection.

Operating teamrelated Factors influenced by the surgeon and operating team include Duration of operation Maintenance of hemostasis and perfusion Avoidance of seroma, hematoma, necrotic tissue, wound drains Tissue handling Cautery use

factors include Patient-related Patient-related Age PaO2 Abdominal procedure Tissue perfusion Presence of foreign body Barrier function Diabetes

Surveillance and quality assurance