Surgical site infection antimicrobials

Harbath S, Samore MH, Lichtenberg D, Carmeli Y Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 2000 101 2916-2921. 

Surgical procedures that necessitate the use of antimicrobial prophylaxis include contaminated and clean-contaminated operations, selected operations in which postoperative infection may be catastrophic such as open heart surgery, clean procedures that involve placement of prosthetic materials, and any procedure in an immunocompromised host. The operation should carry a significant risk of postoperative site infection or cause significant bacterial contamination. 

The host is exposed to the microorganism in a variety of situations relevant to topical antimicrobial compounds. The scenarios tending to infection described below relate to the healthcare setting, but much the same sets of conditions are involved in transmission of foodborne disease via the environmentally or fecally contaminated hands of food handlers. Generally, there is (1) the exposure of patients to pathogenic microorganisms via a healthcare worker s contamination by a different patient, worker, or environmental source (2) the exposure of a patient s surgical site or a worker s wound site to contaminated hands and... 

Before surgical procedures are performed, it is standard that the proposed operative site be prepared with an effective antimicrobial to reduce the microbial populations residing on the skin and, thereby, the potential for surgery-associated infection. Povidone iodine and chlorhexidine gluconate (CHG) have been the two most prevalent antimicrobial choices for preoperative patient skin preparation over the years. In efficacy trials using human volunteers whose baseline counts exceed 10 microorganisms/cm on moist skin sites, both antimicrobial products commonly demonstrate at least a 3 logio reduction in resident skin flora within 10 minutes of skin preparation [1]. When a formulation contains at least 60% alcohol, these reductions are observed within seconds. 

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