While infections are always a risk in transplant allograft patients, xenograft recipients may be at increased risk due to the greater levels of immunosuppression needed and the novel mechanisms of pathogens found in non-human living tissue. For example, potential pathogens from swine range from organisms likely to cause disease in immunocompromised transplant recipients to pathogens known to infect pigs. In addition to concerns about transplant patients themselves, public health concerns center on the possibility that infections could by transmitted by xenograft recipients to the general population.
Unfortunately, there are not enough data to adequately quantify these risks. Preoperative scrubbing of arms and hands for at least 5 minutes prior to surgery and between 2 and 5 minutes for each subsequent procedure. Guideline for prevention of surgical site infection, Infect Control Hosp Epidemiol ; Surgical site infections in cardiac surgery: an year perspective. Am J Infect Control ; The impact of surgical-site infections in the s: attributable mortality, excess length of hospitalization, and extra costs. Estimating health care-associated infections and deaths in U.
Public Health Rep. Scott RD. Hospitals and the Benefits of Prevention. March Centers for Disease Control and Prevention. Antimicrobial management of complicated skin and skin structure infections in the era of emerging resistance. Surg Infect ; Florman S, Nichols RL. Current approaches for the prevention of surgical site infections. Am J Infect Dis ; Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection.
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Clin Infect Dis. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs.
Risk factors for surgical-wound infection following cardiac surgery. J Infect Dis ; Garibaldi RA. Prevention of intraoperative wound contamination with chlorhexidine shower and scrub. J Hosp Infect ;11 Supple B A placebo-controlled trial of the effect of two preoperative baths or showers with chlorhexidine detergent on postoperative wound infection rates.
J Hosp Infect ; Perioperative Standards and Recommended Practices. Connor R, ed. Tentative Final Monograph 43FR Food and Drug Administration. Department of Health and Human Services. Federal Register. Art G. Combination povidone-iodine and alcohol formulations more effective, more convenient versus formulations containing either iodine or alcohol alone: a review of the literature.
J Infus Nurs. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. Darouiche RO, Wall, Jr. Chlorhexidine—alcohol versus povidone—iodine for surgical-site antisepsis.
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N Engl J Med ;; In-use efficacy of a chlorhexidine in alcohol surgical rub: a comparative study. ANZ J Surg ; Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med ; Cardinal Health Medical Products and Services. Active warming systems to maintain perioperative normothermia in hip replacement surgery: a therapeutic aid or a vector of infection?
J Hosp Infect. Leaper D. Effects of local and systemic warming on postoperative infections. Surg Infect. Forced-air warming blowers: An evaluation of filtration adequacy and airborne contamination emissions in the operating room. Am J Infect Control. The Bair Hugger patient warming system in prolonged vascular surgery: an infection risk?
Crit Care. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg ; Long-term glycemic control and postoperative infectious complications. Arch Surg ; Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes.
Diabetes Care ; Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA ; 7; Al-Niaimi A, Safdar N. Supplemental perioperative oxygen for reducing surgical site infection: a meta-analysis. J Eval Clin Pract ; Prospective randomized trial of two wound management strategies for dirty abdominal wounds.
Ann Surg ; Barie PS. Risks associated with SSIs are both related to host and perioperative factors.
Current concepts in managing abdominal sepsis – Global Alliance for Infections in Surgery
However, many of these are modifiable and a concerted effort by the patient and physician surgeon to make changes can improve outcomes. As it has been shown that a vast majority of these infections are preventable, quality initiative programs such as ACS-NSQIP are expanding their roles to help better monitor adherence to improvement measures. Indeed, standardizing preoperative antibiotic prophylaxis timing is perhaps the most persuasive example and this has been integral to reducing postoperative SSI rate. Additional studies are necessary to further evaluate other areas that can be improved upon to reduce SSI rate and ultimately improve the delivery of care to surgical patients.
CDC definitions of nosocomial surgical site infections, a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. Impact of evolving epidemiology on treatments for complicated skin and skin structure infections: the surgical perspective. J Am Coll Surg. Am J Infect Control. Surgical considerations of endogenous infections — sources, types, and methods of control.
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Infect Dis Clin North Am. Complex surgical site infections and the devilish details of risk adjustment: important implications for public reporting. An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery. Dis Colon Rectum.
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Practice guidelines for the diagnosis and management of skin and soft tissue infections: update by the Infectious Diseases Society of America. Clin Infect Dis. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications.
Related Source Control: A Guide to the Management of Surgical Infections
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