Prevention of Perioperative Infection

Fletcher N, Sofianos DM, Berkes MB, Obremskey WT. Prevention of Perioperative Infection. The Journal of Bone & Joint Surgery. 2007;89(7):1605-1618.

Administration of preoperative antibiotics is associated with reduced rates of surgical site infections. Antibiotics should be continued for no longer than twenty-four hours after elective surgery or surgical treatment of closed fractures. Chlorhexidine gluconate is superior to povidone-iodine for preoperative antisepsis for the patient and surgeon. Closed suction drainage is not warranted in elective total joint replacement. It is associated with an increased relative risk of transfusions. Drains left in situ for more than twenty-four hours are at an increased risk for bacterial contamination. The rate of postoperative infections associated with occlusive dressings is lower than that associated with nonocclusive dressings. Appropriate management of blood glucose levels, oxygenation, and the temperature of the patient reduces the risk of postoperative infection. Surgical site infection is one of the most common complications that a surgeon encounters, with an infection occurring after approximately 780,000 operations in the United States each year1. In the era of evidence-based medicine, it is in the best interest of patients and physicians to follow practices backed by basic science and clinical data. Unfortunately, standards of practice, even for the use of prophylactic antibiotics, are frequently not followed2. In 2005, this journal made a commitment to present physicians with the literature to support the best available treatment for their patients with use of “recommendations for care” based on grades of recommendation in review articles3. Grades of recommendation are intended to guide surgeons in determining whether they should change their practice on the basis of good (Grade-A) or fair (Grade-B) recommendations. Grade-A recommendations are generated from Level-I studies, whereas Grade-B recommendations are derived from Level-II or III research. A proposal is considered to be Grade C when there is poor or conflicting evidence concerning an intervention based on Level-IV or V studies, and Grade …

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