Surgeons have moved
away from using staples
to close wounds,
instead opting for sub-
cuticular methods.
Staples alone aren't nec-
essarily a cause of post-
op infection, but they
have been linked with
increased length of
wound drainage, which
is believed to be a mark-
er of infection.
Negative-pressure wound dressings have been critical to our infection
control efforts. The dressings are attached by a plastic tube to a small
pump, which creates a negative pressure at the wound to prevent fluid
from collecting in surrounding tissue. The negative-pressure pump, which
fits in patients' pockets and runs for 7 days, has been shown in 10 random-
ized controlled trials and 6 observational studies involving more than 2,000
wounds to drop infection rates by 58% and lower delayed wound healing
by 30% across multiple specialties. We also apply a silver membrane mesh
that delivers 70 to 100 parts per million silver into the wound. (It takes
about 40 parts per million of silver to kill MRSA.)
4. Limiting blood loss
Increasing numbers of surgeons are opting to perform tourniquet-free
joint replacement surgery, which lowers the risk of hematomas forming
in tissue around joints or hemarthrosis occurring in the joint space, both
of which increase the risk of infection. Forgoing tourniquets to create a
bloodless surgical field requires the use of other methods to control
A U G U S T 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 3 1
• WIPE OUT Treating the skin around the surgical site with chlorhexidine gluconate
the night before surgery and in post-op on the day of surgery is a common step
taken to reduce infection risks.
