Sterile microenvironment in prevention of wound infection.

A prospective controlled trial was carried out to assess the effect of using a wound isolator on reducing postoperative infection. A total of 291 patients undergoing hip pinning for fractures of the neck of femur entered the trial and were allocated at random to have their wound contained in a wound isolator (study group) or dressed with a standard gamma-irradiated adhesive dressing (control group). The bacteriological flora of the patient was monitored before, during, and after operation and that of the ward before and after. No significant difference was found in the flora of the wards in which the patients were nursed. On several occasions the source of the infective organism was traced to the ward but never to the theatre. The isolator prevented direct contamination and airborne cross-infection of the wound and appreciably reduced the rate of infection.     

Prophylaxis of wound infection in patients with head and neck tumors with an account of the pathogen taxonomic pattern]

The most important problem of onkology, i. e. antibiotic prophylaxis and treatment of postoperative infectious complications is touched upon in the paper. The current publications on the problem are discussed and the autors' experience on the treatment is described. The spectrum of the main pathogens of wound infections in patients with head and neck tumors is considered.     

Prophylaxis of infection after appendicectomy: a survey of current surgical practice.

Two hundred and eighty questionnaires were sent to junior surgical staff throughout England inquiring about their use of systemic antibiotic prophylaxis, topical antibacterial agents, and surgical drainage in appendicectomy. One hundred and seventy-five (63%) replies were received from 81 of the 87 hospitals included in the survey. Prophylactic systemic antibiotics were used by 78 surgeons (46%) when operating on a normal appendix but by 168 (99%) when the organ had perforated. Most surgeons started antibiotics before operation, but proportionately fewer did so when the appendix was gangrenous or perforated. Patients with severe contamination tended to receive longer courses of antibiotics, although the duration of administration varied considerably. Metronidazole was included in over 95% of all the prophylactic regimens and was often combined with other drugs when the appendix was gangrenous and perforated. Topical antibacterial agents were applied to the wound routinely by only 45 surgeons (26%), although 106 (61%) used them sometimes. Povidone-iodine was the agent most commonly used. Only 98 surgeons (56%) ever drained appendicectomy wounds, while 135 (77%) sometimes drained the peritoneal cavity. Evidence suggests that present methods of giving systemic antibiotic prophylaxis should continue, but that topical agents and surgical drainage are perhaps unnecessary when surgeons are confident of the efficacy of the systemic treatment used.     

Prophylaxis against systemic infection after transrectal biopsy for suspected prostatic carcinoma.

Five minutes after transrectal prostatic biopsy 16 out of 21 patients were shown by blood culture to have bacteraemia. Antibiotic prophylaxis--routinely with ampicillin and metronidazole for 48 hours--prevented progression to septicaemia, and four days after the procedure all blood samples were negative. Irrespective of whether antibiotic prophylaxis is used, blood culture should be routine in all patients undergoing transrectal prostatic biopsy.     

Behavioral and physiologic effects of inapparent wound infection in rats.

There is a common notion that rats are resistant to postoperative wound infection because many recover from surgery performed under nonsterile conditions. As a result, nonaseptic surgical techniques are used commonly in rat surgery. Our aim was to determine if these techniques cause wound infection and, if so, whether or not the infection, inapparent to casual observation, creates measurable changes in rat physiology and behavior. Rats subjected to craniotomies or laparotomies and inoculated with 10(8) Staphylococcus aureus or Pseudomonas aeruginosa or sterile saline were tested for open-field activity, freezing behavior, home-cage behavior score, and wheel-running activity. Physiologic indices included lactate dehydrogenase, blood glucose, plasma fibrinogen, complete blood counts, wound bacterial counts and histology scores, body temperature, and body weight. Although no clinical signs were detected by postoperative observation, rats inoculated with bacteria were significantly less active in the open field and the duration of freezing behavior was shorter. Plasma fibrinogen, serum glucose, total white blood cell counts, and wound histology scores were significantly altered in the bacteria-inoculated rats. These findings underscore the need for sterile techniques in rat surgery to avoid confounding experimental data.