Guideline for Prevention of Surgical Site Infection, 1999 ☆ ☆☆ ★ ★★

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.

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Guideline for Prevention of Surgical Site Infection, 1999

These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the

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Clinical practice guidelines for antimicrobial prophylaxis in surgery

https://www.amjmed.com/article/0002-9343(91)90361-Z/pdf

Surgical wound infection rates by wound class, operative procedure, and patient risk index

Epidural anesthesia and analgesia. Their role in postoperative outcome.

• A five-year surgical wound surveillance program included the following features: (1) observations were made by a trained nurse-surveyor; (2) all surgical services, without exception, were surveyed; (3) the nurse-surveyor reported directly to the Chief, Surgical Service; (4) all infected wounds and all suspected of harboring an infection were observed daily by the nurse-surveyor; (5) all wounds were inspected on the third and seventh postoperative days, at hospital discharge, and at a follow-up clinic visit; and (6) cultures were obtained from all infected wounds. Data concerning infections for all surgical services were published each month at the mortality-morbidity conference. The number of wounds closed primarily and the number of infected wounds were recorded, together with calculations of wound infection rates by operation class, for each surgical service and for the whole hospital. During the study, the rate of wound infections progressively declined. The overall incidence decreased from 3.5% before the study began to less than 1% at its conclusion. ( Arch Surg 1983;118:303-307)

Effectiveness of a Surgical Wound Surveillance Program

Postoperative ileus: a colonic problem?

Relationship of duration of postoperative ileus to extent and site of operative dissection

Bipolar electrodes were placed in the ascending and descending colon of 13 patients during laparotomy. The magnitude of their operations varied from exploratory laparotomy to total gastrectomy. The magnitude and length of the operations performed did not correlate positively with the duration of postoperative ileus. Signals were recorded for up to 4 hours daily for up to 8 days after operation during periods of rest and, in some patients, after administration of epidural or parenteral morphine sulfate. Power spectrum analyses of electrical control activity (ECA) showed dominant frequencies in both lower (2-9 cpm) and higher (9-14 cpm) ranges. During postoperative recovery, the mean ECA frequencies in right and left colon were relatively constant, but a variety of dominant ECA frequency relationships were observed. The modal pattern in the right colon was a shift in the dominant frequency from the higher to the lower range as recovery progressed, while the modal pattern in the left colon was persistent dominance of ECA in the higher frequency range. Electrical response activity (ERA) initially was comprised of only random, disorganized single bursts but became progressively more complex through the initial 3 postoperative days with the appearance of more organized bursts and clusters, some of which propagated very slowly (about 5 cm/min) both orad and aborad. ERA recovery culminated, typically on the third or fourth postoperative day, with the return of long bursts of continuous ERA, some of which propagated at a higher velocity (about 80 cm/min) and exclusively in the aborad direction and which were accompanied by passage of flatus or by defecation.

Resolution of postoperative ileus in humans.

Data obtained from a survey of the membership of the Society for Surgery of the Alimentary Tract and the American Society of Colon and Rectal Surgeons indicated that concomitant administration of oral neomycin-erythromycin base and systemic cephalothin, together with mechanical colon cleansing, was the most popular method of colon preparation. We designed a prospective double blind clinical trial to compare administration of intravenous cephalothin, oral neomycin-erythromycin base, and the combination of both the intravenous and oral antibiotics. Intake of patients to the intravenous cephalothin group was stopped because the data indicated that this method of prophylaxis resulted in significantly higher numbers of septic complications. The incidence of wound infection was 30 per cent and the overall incidence of septic complications was 39 per cent in patients receiving only intravenous cephalothin combined with mechanical colon cleansing. The incidence of wound infection and the overall incidence of septic complications was only 6 per cent in the comparison group, and the differences are highly significant.

Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: Results of controlled clinical trial: A veterans administration cooperative study

William J. Schulte

Papers

Effectiveness of a Surgical Wound Surveillance Program

Postoperative ileus: a colonic problem?

Relationship of duration of postoperative ileus to extent and site of operative dissection

Resolution of postoperative ileus in humans.

Preoperative prophylactic cephalothin fails to control septic complications of colorectal operations: Results of controlled clinical trial: A veterans administration cooperative study