Introduction
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.