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I N F E C T I O N
P R E V E N T I O N
bial liquid soap for several days before surgery and to apply a body
lotion such as Aveeno to prevent the skin from chapping and drying.
• Bactroban in the nares. He instructs patients to use Bactroban
(mupirocin calcium ointment, 2%) in their nostrils BID for 1 week
before surgery.
• Wash, prep and drape. In the OR, staff wash patients with Hibiclens.
Dr. Cassidy preps patients with DuraPrep or ChloraPrep, then drapes
them with impermeable 10/10 drapes topped by an Ioban antimicrobial incise drape. "This will keep patients clean, dry and warm," he
says. "This also ensures that the graft never touches the patient."
• Rifampicin-soaked mesh. Dr. Cassidy soaks mesh in a concentrated
rifampin solution before implantation. "This helps protect the mesh
from contamination in the air before you even implant it," he says.
• Laparoscopic technique. He does almost all of his hernia repairs
laparoscopically. Studies show infection rates are higher in open hernia repair than in laparoscopic repair. "With a minimally invasive
approach, the mesh is rolled up and put through the port so it doesn't
touch the skin," he says. "You can never make the skin sterile.
Anything you can do to decrease contact improves the chances you'll
get a good outcome."
• Topical skin adhesive. Dr. Cassidy places Dermabond on the wounds.
"I'm doing this more and more, using it as an infection barrier for 48
hours," he says.
Big concern?
The reported incidence of mesh-related infection following hernia
repair has been 1% to 8%. The incidence is influenced by several factors,
including underlying co-morbidities, the type of mesh, the surgical technique and your infection prevention protocols. "Technique and judgment are more crucial than mesh material," says John Kitzmiller, MD,
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | D E C E M B E R 2013
