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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

Main Article

References
  1. Nichols  RL. Postoperative infections in the age of drug-resistant gram-positive bacteria. Am J Med. 1998;104:11S6S. DOIPubMedGoogle Scholar
  2. 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.
  3. 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;121:15967.PubMedGoogle Scholar
  4. 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;185:2648. DOIPubMedGoogle Scholar
  5. 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;65:30913. DOIPubMedGoogle Scholar
  6. 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;11:8993. DOIPubMedGoogle Scholar
  7. 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;13:6068. DOIPubMedGoogle Scholar
  8. Nichols  RL. Prevention of infection in high risk gastrointestinal surgery. Am J Med. 1984;76:1119. DOIPubMedGoogle Scholar
  9. 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;24:3808. DOIPubMedGoogle Scholar
  10. Schaberg  DR. Resistant gram-positive organisms. Ann Emerg Med. 1994;24:4624. DOIPubMedGoogle Scholar
  11. 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;333:14754. DOIPubMedGoogle Scholar
  12. Nichols  RL, Smith  JW. Bacterial contamination of an anesthetic agent. N Engl J Med. 1995;333:1845. DOIPubMedGoogle Scholar
  13. Nichols  RL. Postoperative wound infection. N Engl J Med. 1982;307:17012. DOIPubMedGoogle Scholar
  14. Nichols  RL. Surgical wound infection. Am J Med. 1991;91(Suppl 3B):54S64. DOIPubMedGoogle Scholar
  15. Nichols  RL. Techniques known to prevent postoperative wound infection. Infect Control. 1982;3:347.PubMedGoogle Scholar
  16. 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;20:24780.PubMedGoogle Scholar
  17. Nichols  RL. Surgical infections: prevention and treatment--1965 to 1995. Am J Surg. 1996;172:6874. DOIPubMedGoogle Scholar
  18. Burke  JF. The effective period of preventive antibiotic action in experimental incision and dermal lesions. Surgery. 1961;50:1618.PubMedGoogle Scholar
  19. 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;56:1519.PubMedGoogle Scholar
  20. Nichols  RL. Surgical bacteriology: an overview. In: Nyhus LM, editor. Surgery annual. Vol 13. New York: Appleton-Century-Crofts; 1981. p. 205-38.
  21. Antimicrobial prophylaxis in surgery.. Med Lett Drugs Ther. 1999;41:7580.PubMedGoogle Scholar
  22. 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;322:15360. DOIPubMedGoogle Scholar
  23. Nichols  RL. Antibiotic prophylaxis in surgery. Curr Opin Infect Dis. 1994;7:64752. DOIGoogle Scholar
  24. Nichols  RL, Condon  RE. Preoperative preparation of the colon. Surg Gynecol Obstet. 1971;132:32337.
  25. Nichols  RL, Condon  RE. Antibiotic preparation in the colon: failure of commonly used regimens. Surg Clin North Am. 1971;51:22331.PubMedGoogle Scholar
  26. 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;24:60919. DOIPubMedGoogle Scholar
  27. Nichols  RL, Condon  RE, Gorbach  ST, Nyhus  LM. Efficacy of preoperative antimicrobial preparation of the bowel. Ann Surg. 1972;176:22732. DOIPubMedGoogle Scholar
  28. Bennion  RS, Thompson  JE, Baron  EJ, Finegold  SM. Gangrenous and perforated appendicitis with peritonitis: treatment and bacteriology. Clin Ther. 1990;12(Suppl C):3144.PubMedGoogle Scholar
  29. Browder  W, Smith  JW, Vivoda  L, Nichols  RL. Nonperforative appendicitis: a continuing surgical dilemma. J Infect Dis. 1989;159:108894.PubMedGoogle Scholar
  30. Nichols  RL, Smith  JW, Klein  DB, Trunkey  DD, Cooper  RH, Adinolfi  MF. Risk of infection after penetrating abdominal trauma. N Engl J Med. 1984;311:106570. DOIPubMedGoogle Scholar
  31. Nichols  RL, Smith  JW, Robertson  GD, Muzik  AC, Pearce  P, Ozmen  V. Prospective alterations in therapy for penetrating abdominal trauma. Arch Surg. 1993;128:5564.PubMedGoogle Scholar
  32. Cant  PJ, Smyth  S, Smart  DO. Antibiotic prophylaxis is indicated for chest stab wound requiring closed tube thoracotomy. Br J Surg. 1993;80:4646. DOIPubMedGoogle Scholar
  33. 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;106:14938. DOIPubMedGoogle Scholar

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Page updated: May 10, 2011
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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.
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