An ounce of prevention is worth a pound of cure

Abstract

In cardiac surgery,patient characteristics possibly associated with an increased risk of surgical site infection include coincident remote site bacterial colonization, diabetes, systemic steroid use, obesity, and the extremes of age. The most modifiable of these risk factors is that of coincident preoperative nares colonization with Staphylococcus aureus. Such carriage is a powerful independent risk factor for surgical site infection after cardiac operations. Mupirocinointmentisaneffectivetopicalagentagainstthishazard, and treatment is indicated for all patients. Current consensus is that broad use of the antibiotic is unlikely to result in mupirocin resistance because treatment courses are brief. 3 Operative issues may be further categorized into interventions that occur during specific periods: intraoperative and postoperative. The intraoperative infection control measures recommended by the Centers for Disease Control andPreventioninclude hairclippingimmediatelybeforethe operation, antimicrobial prophylaxis in accordance with evidence-based standards and guidelines, and use of appropriate antiseptic agents and techniques for skin preparation. 3 Miyahara and colleagues 2 add to the list additional maneuvers that include the use of an iodophorimpregnated drape, double-gloving for all surgical team members, scheduled glove changes, minimization of intraoperative steroids, pericardial irrigation, and secure sternal closure with at least 6 wires. Best practices of postoperative infection control include measures nicely outlined by the Centers for Disease Control andPrevention 3 andMiyaharaandcolleagues. 2 Theseinclude