surgery. This is a logical step given that most surgical site infections
are caused by a patient's own skin flora. The problem is that there is
a paucity of high-quality evidence identifying the optimal timing of
pre-op bathing or the most effective cleansing agent to use. Most
protocols dictate bathing at least the night before surgery, though
some recommend additional bathing the morning of surgery.
The most widely used agent for preoperative bathing is arguably
CHG, owing to its broad spectrum of activity and persistent antimicro-
bial effect. However, evidence has not borne out the superiority of CHG
in preoperative bathing compared to plain or other antimicrobial soaps.
• Maintaining normothermia. Perioperative normothermia is nec-
essary for maintaining normal blood flow and for optimal immune
system function. By contrast, perioperative hypothermia is a known
risk factor for adverse events including intraoperative blood loss,
cardiac events, coagulopathy and surgical site infections. Peri-oper-
ative hypothermia can result from thermoregulatory dysfunction
during anesthesia or exposure to the surgical environment.
There are multiple devices available to prevent perioperative
hypothermia, from heated mattresses to circulating water garments
to forced-air warming and resistive-heating devices.
• Antibiotic prophylaxis. A large body of evidence gives proof to the
concept that administering antibiotics before incisions are made
reduces the bacterial load in and around the surgical site, resulting in
a lower risk of infection. But exactly how long before incisions they
should be given, whether the dosing should be adjusted based on a
patient's weight and how many doses are needed are sources of
ongoing debate. — Helen Johnson, MD
Dr. Johnson (hboehm705@gmail.com) is a freelance medical writer based
in Vero Beach, Fla.
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