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INTRODUCTION

As recently as the early 20th century, infection after surgery and related mortality was considered nearly inevitable. With increasing acceptance of microbes as the cause of infection, the importance of antisepsis around surgical procedures, and increasing availability of antibiotics to treat postoperative infections and later for prophylaxis, the rate of infections related to surgery has dropped dramatically. However, surgical site infections (SSIs) remain the most common and most costly category of nosocomial infections, accounting for 20% of hospital-acquired infections.

To facilitate surveillance of postsurgical infections that allow comparison and benchmarking, the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) defines surgical site infection as infection related to an operative procedure that occurs at or deep to the surgical incision (incisional, deep, or organ space) within 30–90 days of the procedure depending on depth or presence of prosthetic material implanted at surgery.1 Clinical criteria are summarized in Table 7-1.

TABLE 7-1Clinical Criteria for Defining Surgical Site Infections

It is estimated that 2–5% of hospital inpatients undergoing surgery will suffer a surgical wound infection. SSIs prolong length of stay by an average 9.7 days and increase overall cost by over $20,000 per hospitalization. Additionally, more than 900,000 readmissions costing another $700 million are attributed to SSIs.2

RISK FACTORS

Bacterial contamination through surgical ...

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