Surgical infection still causes considerable morbidity and high costs to the health-care systems, and is becoming increasingly important in medicolegal aspects. Although antibiotic prophylaxis, utilising single high-dose broad-spectrum antibiotics, is important, it has unfortunately tended to lull surgeons into a state of unjustified security where too little attention to sterile precautions, and particularly surgical technique, is paid.
Wound infection results from bacterial contamination of the wound. Infection rate is proportionate to:
• number of bacteria;
• type of bacteria;
• incisions involving mucus surfaces;
• sites of existing infection in the body;
• the use of prosthetic implants.
An appreciation of the sources of bacteria is important and in abdominal surgery these may be summarised as:
1.endogenous from the patient’s viscera (98 per cent);
2.endogenous from the patient’s skin;
3. contamination from the air in the operating theatre — rare (by comparison, in 98 per cent of orthopaedic infections the contaminating organisms are ultimately derived from the air with 30 per cent of these sedimenting directly into the wound and the remainder on to drapes and then become dislodged into the wound);
4. direct contamination, such as punctured gloves — very uncommon.
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