Volume 7, Number 2—April 2001
THEME ISSUE
4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections
Prevention is Primary
Preventing Surgical Site Infections: A Surgeon's Perspective
Table 1
Hospital Infection Control Practices Advisory Committee (HICPAC) Partial Recommendations for the Prevention of Surgical Site Infection-1999 (16)
Rankings | |
---|---|
Category 1A | Strongly recommended for implementation and supported by well-designed experimental, clinical, or epidemiologic studies |
Category 1B | Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and strong theoretical rationale |
Category II | Suggested for implementation and supported by suggestive clinical or epidemiologic studies or theoretical rationale |
No recommendation; unresolved issue. | Practices for which insufficient evidence or no consensus regarding efficacy exists |
Recommendations | |
Preoperative--partial and modified | |
A. Preparation of the patient | |
Category 1A | Treat remote infection before elective operation; postpone surgery until treated Do not remove hair from operative site unless necessary to facilitate surgery If hair is removed, do immediately before surgery, preferably with electric clippers |
Category 1B | Control serum blood glucose perioperatively Cessation of tobacco use 30 days before surgery Do not withhold necessary blood products to prevent SSIs Shower or bath on night before operative procedure Wash incision site before performing antiseptic skin preparation with approved agent |
Category II | Prepare skin in concentric circles from incision site Keep preoperative stay in hospital as short as possible |
Unresolved | Improve nutritional status Use of mupirocin in nares Improve oxygenation of wound space Taper or discontinue systemic steroid use before elective surgery |
B. Antimicrobial prophylaxis | |
Category 1A | Select (if indicated) an antimicrobial agent with efficacy against expected pathogen Intravenous route used to ascertain adequate serum levels during operation and for at most a few hours after incision closed Before elective colorectal operations, in addition to parenteral agent, mechanically prepare the colon by use of enemas and cathartics. Administer nonabsorbable oral antimicrobial agents in divided doses on the day before the operation |
Category 1B | Do not routinely use vancomycin for antimicrobial prophylaxis |
SSI = surgical site infections |
References
- Nichols RL. Postoperative infections in the age of drug-resistant gram-positive bacteria. Am J Med. 1998;104:11S–6S. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. National Center for Health Statistics Vital and Health Statistics, Detailed diagnoses and procedures national hospital discharge survey 1994. Vol 127. Hyattsville (MD): Department of Health and Human Services; 1997.
- Haley RW, Culver DH, White JW, Morgan WM, Emori TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol. 1985;121:159–67.PubMedGoogle Scholar
- Green JW, Wenzel RP. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg. 1977;185:264–8. DOIPubMedGoogle Scholar
- Taylor GJ, Mikell FL, Moses HW, Dove JT, Katholi RE, Malik SA. Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications. Am J Cardiol. 1990;65:309–13. DOIPubMedGoogle Scholar
- Boyce JM, Potter-Bynoe G, Dziobek L. Hospital reimbursement patterns among patients with surgical wound infection following open heart surgery. Infect Control Hosp Epidemiol. 1990;11:89–93. DOIPubMedGoogle Scholar
- Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–8. DOIPubMedGoogle Scholar
- Nichols RL. Prevention of infection in high risk gastrointestinal surgery. Am J Med. 1984;76:111–9. DOIPubMedGoogle Scholar
- Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control. 1996;24:380–8. DOIPubMedGoogle Scholar
- Schaberg DR. Resistant gram-positive organisms. Ann Emerg Med. 1994;24:462–4. DOIPubMedGoogle Scholar
- Bennett SN, McNeil MM, Bland LA, Arduino MJ, Villarino ME, Perrotta DM. Postoperative infections traced to contamination of an intravenous anesthetic, propofol. N Engl J Med. 1995;333:147–54. DOIPubMedGoogle Scholar
- Nichols RL, Smith JW. Bacterial contamination of an anesthetic agent. N Engl J Med. 1995;333:184–5. DOIPubMedGoogle Scholar
- Nichols RL. Techniques known to prevent postoperative wound infection. Infect Control. 1982;3:34–7.PubMedGoogle Scholar
- Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. the Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection 1999. Infect Control Hosp Epidemiol. 1999;20:247–80.PubMedGoogle Scholar
- Nichols RL. Surgical infections: prevention and treatment--1965 to 1995. Am J Surg. 1996;172:68–74. DOIPubMedGoogle Scholar
- Burke JF. The effective period of preventive antibiotic action in experimental incision and dermal lesions. Surgery. 1961;50:161–8.PubMedGoogle Scholar
- Bernard HR, Cole WR. The prophylaxis of surgical infection: the effect of prophylactic antimicrobial drugs on the incidence of infection following potentially contaminated operations. Surgery. 1964;56:151–9.PubMedGoogle Scholar
- Nichols RL. Surgical bacteriology: an overview. In: Nyhus LM, editor. Surgery annual. Vol 13. New York: Appleton-Century-Crofts; 1981. p. 205-38.
- Platt R, Zalenik DF, Hopkins CC, Dellinger EP, Karchmer AW, Bryan CS. Perioperative antibiotic prophylaxis for herniorrhaphy and breast surgery. N Engl J Med. 1990;322:153–60. DOIPubMedGoogle Scholar
- Nichols RL. Antibiotic prophylaxis in surgery. Curr Opin Infect Dis. 1994;7:647–52. DOIGoogle Scholar
- Nichols RL, Condon RE. Preoperative preparation of the colon. Surg Gynecol Obstet. 1971;132:323–37.
- Nichols RL, Condon RE. Antibiotic preparation in the colon: failure of commonly used regimens. Surg Clin North Am. 1971;51:223–31.PubMedGoogle Scholar
- Nichols RL, Smith JW, Garcia RV, Waterman RS, Holmes JWC. Current practices of preoperative bowel preparation among North American colorectal surgeons. Clin Infect Dis. 1997;24:609–19. DOIPubMedGoogle Scholar
- Nichols RL, Condon RE, Gorbach ST, Nyhus LM. Efficacy of preoperative antimicrobial preparation of the bowel. Ann Surg. 1972;176:227–32. DOIPubMedGoogle Scholar
- Bennion RS, Thompson JE, Baron EJ, Finegold SM. Gangrenous and perforated appendicitis with peritonitis: treatment and bacteriology. Clin Ther. 1990;12(Suppl C):31–44.PubMedGoogle Scholar
- Browder W, Smith JW, Vivoda L, Nichols RL. Nonperforative appendicitis: a continuing surgical dilemma. J Infect Dis. 1989;159:1088–94.PubMedGoogle Scholar
- Nichols RL, Smith JW, Klein DB, Trunkey DD, Cooper RH, Adinolfi MF. Risk of infection after penetrating abdominal trauma. N Engl J Med. 1984;311:1065–70. DOIPubMedGoogle Scholar
- Nichols RL, Smith JW, Robertson GD, Muzik AC, Pearce P, Ozmen V. Prospective alterations in therapy for penetrating abdominal trauma. Arch Surg. 1993;128:55–64.PubMedGoogle Scholar
- Cant PJ, Smyth S, Smart DO. Antibiotic prophylaxis is indicated for chest stab wound requiring closed tube thoracotomy. Br J Surg. 1993;80:464–6. DOIPubMedGoogle Scholar
- Nichols RL, Smith JW, Muzik AC, Love EJ, McSwain NE, Timberlake G. Preventive antibiotic usage in traumatic thoracic injuries requiring closed tube thoracotomy. Chest. 1994;106:1493–8. DOIPubMedGoogle Scholar
Page created: May 10, 2011
Page updated: May 10, 2011
Page reviewed: May 10, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.