Surgical site infection prevention: how we do it

Abstract

Background: Efforts to prevent surgical site infection (SSI) employ methods that are valid scientifically, but each institution and each surgeon also incorporates methods believed to be useful although this has not been proved by clinical trials.

Methods: The surgical literature was reviewed, as were practices at the University of Virginia that the authors believe are of value for the prevention of SSI.

Results: Preventive antibiotics are established measures. A case can be made for increasing the dose in patients with a large body mass, and antibiotics probably should be re-administered during procedures lasting longer than 3 h. Chlorhexidine showers for the patient are not proven; however, they are inexpensive and of potential benefit. Hair removal is always done with clippers and in the operating room at the time of the procedure. No scientific case can be made specifically for using antiseptic at the surgical site before the incision. Keeping the blood glucose concentration and the core body temperature near normal probably are important, but how close to normal is unclear. Transfusion enhances SSI, but leukocyte reduction of transfused blood may be of benefit. Some evidence supports the value of antibacterial suture in preventing SSI.

Conclusions: Many proven and potentially valid methods are employed to prevent SSI. Coordinated and standardized protocols with good data collection can assist the multi-disciplinary efforts to reduce SSI within the unique practices of a given institution.

FIG. 1.

The enemy. Seventy-eight year old woman six days after left above-knee amputation for acute lower-extremity ischemia presented with superficial surgical site infection. Photograph shows areas of erythema, necrosis, and epidemolysis at the incision site.

FIG. 2.

Differences in surgical site infection rates in general surgery patients according to type of skin preparation used over an 18-month period at the University of Virginia.