Influence of skin flora and preventive measures on surgical site infection during cardiac surgery.

Background: The skin flora responsible for most surgical site infections (SSIs) include Staphylococcus aureus, coagulase-negative staphylococci, Propionibacterium acnes, gram-negative bacilli, micrococci, and diphtheroids. The two major methods of reducing local concentrations of bacteria are administration of an antibiotic and cleansing of the skin. Resistance to antibiotics is a major concern. Mortality rates in patients infected by methicillin-resistant Staphylococcus aureus or comparably virulent bacteria may be as high as 74%.

Methods: Review of current practice and guidelines.

Results: There is no standard regimen for antimicrobial prophylaxis. No added benefit is conferred by prophylaxis exceeding 48 h. A number of preoperative skin care techniques have been used to limit concentrations of bacteria at the surgical site, including antiseptic preparations, adhesive barrier drapes, topical antibiotics, hair removal, and hand hygiene.

Conclusions: Antibiotic prophylaxis minimizes the risk of SSI in patients having cardiac surgery. The emergence of antibiotic-resistant bacteria makes it necessary to avoid the use of antimicrobials when they are not necessary. Preoperative skin care does reduce contamination at the incisional site and may reduce the risk of SSI.