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Surgical site infection is caused by exogenous or endogenous bacteria; infection is influenced not only by the source of the infecting inoculum but also by the bacterial characteristics.
Ensure that prophylactic antibiotics, if indicated, are present in tissue in adequate concentrations at beginning of operation.
Remote sites of infection Postpone elective operation if possible. Treat remote infection appropriately.
Skin
Bowel
Nature and site of operation Is the operation Clean Cleancontaminated Contaminated Dirty or infected
Operating teamrelated Comportment Use of impermeable drapes and gowns Surgical scrub
Preventive measures to control bacteria Decontamination of patient's skin [see Sidebar Preoperative Preparation of the Operative Site] Additional antibiotics if indicated, depending on likelihood of contamination and on bacterial inoculum and properties [see Sidebar Antibiotic Prophylaxis of Infection]
BACTERIA
HOST DEFENSE MECHANISMS Factors contributing to dysfunction of host defense mechanisms can be related to surgical disease, to events surrounding the operation, to the patients underlying disease, and to anesthetic management.
SURGICAL SITE Surgeon-related Factors influenced by the surgeon include Preoperative decisions Timing of operation Surgical technique Transfusion Blood loss Duration and extent of operation Glucose control Tissue oxygenation (mask)
Patient-related Patient-related factors include Presence of 3 concomitant diagnoses Underlying disease Age Drug use Preoperative nutritional status Smoking
Anesthesiologist-related Normothermia Normovolemia Pain control Tissue oxygenation Glucose control Sterility of drugs
Local factors influence the susceptibility of the wound environment by affecting the size of the inoculum required to produce infection.
Operating teamrelated Factors influenced by the surgeon and operating team include Duration of operation Maintenance of hemostasis and perfusion Avoidance of seroma, hematoma, necrotic tissue, wound drains Tissue handling Cautery use
factors include Patient-related Patient-related Age PaO2 Abdominal procedure Tissue perfusion Presence of foreign body Barrier function Diabetes