From the Guidelines
To prevent and decrease the risk of surgical site infection after abdominal surgery, the best answer is E. Prevent perioperative hypothermia. Maintaining normal body temperature during surgery significantly reduces infection rates by preserving immune function and optimizing tissue perfusion. When patients become cold during surgery, their immune defenses weaken, blood vessels constrict reducing oxygen delivery to tissues, and wound healing is impaired. Studies show that even mild hypothermia (1-2°C below normal) can double or triple infection rates. Practical measures include using warming blankets, warmed IV fluids, increasing ambient operating room temperature, and active warming devices before, during, and after surgery.
While antiseptics (option A) are important, they alone are insufficient, as noted in the study by 1. Option B (shaving at night) actually increases infection risk as it creates microtrauma; if hair removal is necessary, clipping immediately before surgery is preferred. Option C combines antibiotics with LMWH (low molecular weight heparin), which addresses thrombosis prevention but not specifically infection control, as discussed in 1. Option D is incomplete as "prophylactic" could refer to various measures.
Some key points to consider in preventing surgical site infections include:
- The use of triclosan-coated suture, which significantly reduces SSI prevalence compared with non-coated sutures, as found in 1.
- The application of negative-pressure wound therapy, which may be effective in reducing postoperative wound complications, especially in patients with a high risk of infection, as mentioned in 1.
- The importance of intraoperative normothermia in decreasing the rate of SSI, as highlighted in 1.
- The suggestion of prophylactic wound irrigation in clean, clean-contaminated, and contaminated fields of surgery, without the use of antibiotic irrigation, as recommended in 1.
Preventing hypothermia represents a comprehensive, evidence-based approach that directly addresses the physiological factors that contribute to surgical site infections, and is supported by the most recent and highest quality studies, including 1.
From the Research
Prevention of Surgical Site Infection
To prevent and decrease the risk of surgical site infection after abdominal surgery, several strategies can be employed:
- Use of prophylactic antibiotics within 12 hours before surgery, as recommended by 2
- Maintenance of normothermia throughout the perioperative period to reduce the risk of surgical site infection, as supported by 3 and 4
- Use of chlorhexidine-based skin antisepsis, as recommended by 3 and 4
- Avoiding razors for hair removal, as suggested by 3
- Decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures, as recommended by 3
- Controlling perioperative glucose concentrations, as suggested by 3
- Use of negative pressure wound therapy, as recommended by 3
- Use of triclosan-coated suture for incision closure, as recommended by 5
Why Not Antiseptic Before Operation Alone?
While antiseptic preparation of the surgical site is an important aspect of preventing surgical site infection, as mentioned in 6, it is not sufficient on its own to prevent infection. A multi-disciplinary approach, including the use of prophylactic antibiotics, maintenance of normothermia, and other strategies, is necessary to reduce the risk of surgical site infection, as supported by 3, 4, and 2.
Additional Considerations
Shaving at night before surgery is not recommended, as it can increase the risk of surgical site infection, as suggested by 3. Instead, hair removal should be done using clippers, if necessary. Low Molecular Weight Heparin (LMWH) may be used for prophylaxis against venous thromboembolism, but its use in preventing surgical site infection is not directly related, although it may be part of the overall perioperative care plan.