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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

Ronald Lee NicholsComments to Author 
Author affiliation: Tulane University School of Medicine, New Orleans, Louisiana, USA

Main Article

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

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