Epidemiology and etiology

Numerous risk factors for SSI have been identified in the literature. ' ' These factors can be divided into two categories: patient and operative characteristics. Patient risk factors for SSI include: age, comorbid disease states (especially chronic lung disease and diabetes), malnutrition, immunosuppression, nicotine or steroid use, and colonization of the nares with Staphylococcus aureus. Many patients developing postoperative wound infections bring the organism with them into the hospital. Modifying risk factors may decrease the threat of SSI. Malnutrition can be corrected using enteral or parenteral feedings. Additional nonantimicrobial strategies to reduce SSI will be discussed later.

Operative characteristics are based on the actions of both the patient and the operating staff. Shaving of the surgical site prior to operating can produce microscopic lacerations and increase the chance of SSI and is, therefore, not accepted as a method of hair removal.5 Maintaining aseptic technique and proper sterilization of medical equipment is effective in preventing SSI. Surgical staff should wash their hands thoroughly. In clean surgeries, most bacterial inoculums introduced postoperatively are generally small. However, subsequent patient contact between contaminated areas (nares or rectum) and the surgical site can lead to SSI. Finally, the appropriate use of antimicrobial prophylaxis can have a significant impact on decreasing SSIs.

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