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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

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Table 2

Changes in CDC surgical site infections prevention guidelines, 1999 (16)

1985 1999
Category 1 Category 1A
Category II Category 1B
Category III Category II or no recommendation; unresolved
Preoperative hair removal
Do not remove hair unless it will interfere with the operation Recommendation unchanged
Category II Category 1A
If removed, remove by clipping or use of a depilatory, not by shaving If removed, preferably remove immediately before the operation with electric clippers
Category II Category 1A
Preoperative shower or bath
Patient should bathe with antimicrobial soap the night before an elective operation Require patients to shower or bathe with an antiseptic agent at least the night before surgery
Category III Category 1B
Preoperative hand and forearm antisepsis
Perform surgical scrub for at least 5 minutes before first operation of day Perform surgical scrub for at least 2-5 minutes with an appropriate antiseptic
Category 1 Category 1B
Between consecutive operations perform surgical scrub 2 to 5 minutes
Category II
After scrub, dry hands with sterile towel, don sterile gown and gloves After scrub, keep hands up and away from body; dry hands with sterile towel; don sterile gown and gloves
Category 1 Category 1B
Preoperative patient preparation
Treat and control all bacterial infections before operation Identify and treat all remote infections before elective operation
Category 1 Category 1A
The hospital stay should be as short as possible Keep hospital stay as short as possible
Category II Category II
If patient is malnourished, enteral or parenteral nutrition should be given No recommendation to use nutritional support solely to prevent surgical site infection
Category II Unresolved
Preoperative antimicrobial prophylaxis
Use for operations with high infection rate or for those with severe or life-threatening consequences if infection occurs Administer antimicrobial agent only when indicated and select based on published recommendations for a specific operation and efficacy against most common pathogens
Category 1 Category 1A
Select antimicrobial agents that are safe and effective
Category 1
Start parenteral IV antimicrobial agents shortly before operation and discontinue shortly afterward Administer antimicrobial agents by IV timed to ensure bactericidal serum and tissue levels when incision made
Category 1 Category 1A
Maintain therapeutic levels during operation and, at most, a few hours after closure
Category 1A
Before colorectal elective operations, in addition to IV antimicrobial drugs, mechanically prepare the colon with enemas and cathartic agents; administer nonabsorbable oral antimicrobial agents in individual doses the day before surgery
Category 1A
For cesarean sections in patients at high risk administer IV antimicrobial agent immediately after cord is clamped
Category 1A
Do not routinely use vancomycin for prophylaxis
Category 1B

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