Updated Recommendations for Control of Surgical Site Infections

J. Wesley Alexander, MD, ScD; Joseph S. Solomkin, MD; Michael J. Edwards, MD


Annals of Surgery. 2011;253(6):1082-1093. 

In This Article

Reduction in Contamination (Asepsis) Operating Room Environment

The CDC guidelines[3] and regulations from various accrediting agencies are good resources for providing details related to effective techniques for air handling, cleaning of environmental surfaces, sterilization techniques, activities of surgical team members, surgical attire, drapes, and asepsis. These should, in general, be regarded as recommendations which are set in stone.

Microbes in the air of the operating room can be an important source of pathogens for causing wound infections. High efficiency particulate air (HEPA) filters provide the best environment (SDC-9). Laminar flow systems may help, but show minimal protective effect on the incidence of surgical site infection compared to HEPA filtration (SDC-10). Limiting traffic and idle conversations in the operating room (OR) are essential to reducing airborne bacteria.

A major source of contamination of the operative wound is related to perforation of surgical gloves. In a recent study of 4147 surgical procedures, there was a higher likelihood of SSI in procedures in which gloves were perforated compared to procedures where they were not perforated (odds ratio, OR = 2.0) (SDC-11). The risk of infection with glove perforation was significantly greater in those procedures in which no antimicrobial prophylaxis was given. In an analysis of 655 surgical operations, perforations were found to occur in 31% (SDC-12). Double-indicator gloves made the intraoperative detection of perforations much easier. Using double gloving techniques, perforation of the outer glove was associated with less perforation of the inner glove (OR = 0.10) (SDC-13). Strike-through in operating gowns, particularly at the sleeve or abdominal area is also a potential source for contamination that is often neglected.


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