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Background: Surgical antibiotic prophylaxis practice became common in the 1970s and has since become almost universal. The earliest articles used three doses over 12 hours with the first being administered before the start of the operation. Conclusions: The duration of prophylaxis has varied widely in practice over time, but an increasing body of evidence has supported shorter durations, most recently with recommendations in influential guidelines to avoid administration after the incision is closed. [ABSTRACT FROM AUTHOR]

Objective: Reduction of surgical site infection. Methods: Retrospective evaluation of a surgical infection prevention program consisting of the gradual introduction of specific infection prevention methods and a surveillance system identifying and reporting on potentially preventable surgical site infections as defined by the omission of a preventive method. Setting: A university tertiary referral medical center. Results: The sequential introduction of infection prevention elements in the bundle resulted in a fluctuating rate of potentially preventable surgical site infections simultaneously with a slow, gradual reduction of the clean wound SSI rate. Conclusions: Change in a complex, multidisciplinary environment such as an inpatient surgical unit happens gradually and requires focused attention and input from all involved professionals. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections have been a concern for many years, and decades-old articles demonstrate the benefit of surveillance and reporting of these infections with resulting decrease in incidence. Comprehensive surveillance is difficult and often incomplete and is hampered when patients must travel a distance for surgical care. In recent years there has been increasing interest in patient-generated health data (PGHD) that includes patients taking photographs of their surgical incisions. Methods: A selective review of articles on PGHD and photographic images was undertaken in combination with interviews of investigators in this field. Results: There is a possibility that a well-developed system to facilitate patient-provided images of the surgical incision to surgical care providers in a Health Insurance Portability and Accountability Act (HIPAA)-compliant manner could improve surgical surveillance and reduce unnecessary post-operative visits. Conclusions: Further study is required. [ABSTRACT FROM AUTHOR]

Much has been done to identify measures and modify risk factors to decrease the rate of surgical site infection (SSI). Development of the Centers for Disease Control and Prevention (CDC) Core recommendations for the prevention of SSI revealed evidence gaps in six areas: Parenteral antimicrobial prophylaxis, glycemic control, normothermia, oxygenation, antiseptic prophylaxis, and non-parenteral antimicrobial prophylaxis. Using a modified Delphi process, seven SSI content experts identified nutritional status, smoking, obesity, surgical technique, and anemia as additional areas for SSI prevention research. Post-modified Delphi process Staphylococcus aureus colonization and SSI definition and surveillance were also deemed important topic areas for inclusion. For each topic, research questions were developed, and 10 were selected as the final SSI research questions. [ABSTRACT FROM AUTHOR]

Background: Hospital-acquired infections (HAIs) are a persistent concern and include surgical site infections, intravascular line-associated infections, pneumonia, catheter-associated urinary tract infections, and C. difficile infection.Method: Review of the pertinent English-language literature.Results: Hospital-acquired infections result in significant increases in morbidity, mortality rates, and cost and are a focus of efforts at reduction.Conclusion: I discuss efforts specific to each of the most common infections and a philosophical approach to prevention that strives to achieve zero potentially preventable hospital-acquired infections. [ABSTRACT FROM AUTHOR]

Background: The surgeon has been regarded as the "captain of the ship" in the operating room (OR) for many years, but cannot accomplish successful operative intervention without the rest of the team.Methods: Review of the pertinent English-language literature.Results: Many reports demonstrate very different impressions of teamwork and communication in the OR held by different members of the surgical team. Objective measures of teamwork and communication demonstrate a reduction in complications including surgical site infections with improved teamwork and communication, with fewer distractions such as noise, and with effective use of checklists.Conclusion: Efforts to improve teamwork and communication and promote the effective use of checklists promote patient safety and improved outcomes for patients with reduction in surgical site infections. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSI) account for a major proportion of hospital-acquired infections. They are associated with longer hospital stay, readmissions, increased costs, mortality, and morbidity. Reducing SSI is a goal of the Surgical Care Improvement Project and identifying interventions that reduce SSI effectively is of interest. In a single-blinded randomized controlled trial (RCT) we evaluated the effect of localized warming applied to surgical incisions on SSI development and selected cellular (immune, endothelial) and tissue responses (oxygenation, collagen).Methods: After Institutional Review Board approval and consent, patients having open bariatric, colon, or gynecologic-oncologic related operations were enrolled and randomly assigned to local incision warming (6 post-operative treatments) or non-warming. A prototype surgical bandage was used for all patients. The study protocol included intra-operative warming to maintain core temperature ≥36°C and administration of 0.80 FIO2. Patients were followed for 6 wks for the primary outcome of SSI determined by U.S. Centers for Disease Control (CDC) criteria and ASEPSIS scores (additional treatment; presence of serous discharge, erythema, purulent exudate, and separation of the deep tissues; isolation of bacteria; and duration of inpatient stay). Tissue oxygen (PscO2) and samples for cellular analyses were obtained using subcutaneous polytetrafluoroethylene (ePTFE) tubes and oxygen micro-electrodes implanted adjacent to the incision. Cellular and tissue ePTFE samples were evaluated using flow cytometry, immunohistochemistry, and Sircol™ collagen assay (Biocolor Ltd., Carrickfergus, United Kingdom).Results: One hundred forty-six patients participated (n=73 per group). Study groups were similar on demographic parameters and for intra-operative management factors. The CDC defined rate of SSI was 18%; occurrence of SSI between groups did not differ (p=0.27). At 2 wks, warmed patients had better ASEPSIS scores (p=0.04) but this difference was not observed at 6 wks. There were no significant differences in immune, endothelial cell, or collagen responses between groups. On post-operative days one to two, warmed patients had greater PscO2 change scores with an average PscO2 increase of 9-10 mm Hg above baseline (p<0.04).Conclusions: Post-operative local warming compared with non-warming followed in this study, which included intra-operative warming to maintain normothermia and FIO2 level of 0.80, did not reduce SSI and had no effect on immune, endothelial cell presence, or collagen synthesis. PscO2 increased significantly with warming, however, the increase was modest and less than expected or what has been observed in studies testing other interventions. [ABSTRACT FROM AUTHOR]