Key Points
����Prophylaxis refers to the prevention of an infection and can be
characterized as primary prophylaxis, secondary prophylaxis,
or eradication. These guidelines focus on primary perioperative
prophylaxis ��� the prevention of an initial infection.
����Prophylaxis is recommended in some cases due to the severity of
complications of postoperative infection (eg, an infected device that
is not easily removable) necessitating precautionary measures even if
infection is unlikely.
����Patient-related factors associated with an increased risk of surgical
site infection (SSI) include extremes of age, nutritional status, obesity,
diabetes mellitus, tobacco use, coexistent remote body site infections,
altered immune response, corticosteroid therapy, recent surgical
procedure, length of preoperative hospitalization, and colonization
with microorganisms.
������ Antimicrobial prophylaxis may be justified for any procedure if the patient
has an underlying medical condition associated with a high risk of SSI or if
the patient is immunocompromised (eg, malnourished, neutropenic, receiving
immunosuppressive agents).
����Although antimicrobial prophylaxis plays an important role in reducing
the rate of SSIs, other factors may have a strong impact on SSI rates.
These include:
������ Attention to basic infection control strategies
������ The surgeon���s experience and technique
������ Duration of procedure
������ Hospital and operating room environments
������ Instrument sterilization
������ Preoperative preparation (eg, surgical scrub, skin antisepsis, and appropriate ���
hair removal)
������ Perioperative management (temperature and glycemic control)
������ The underlying medical condition of the patient
Definitions
National Healthcare Safety Network (NHSN) Wound
Classification Criteria
����Clean: An uninfected operative wound in which no inflammation is
encountered and the respiratory, alimentary, genital, or uninfected
urinary tracts are not entered.
������ In addition, clean wounds are closed primarily and, if necessary, drained with
closed drainage.
������ Operative incisional wounds that follow nonpenetrating (blunt) trauma should be
included in this category if they meet the criteria.