Abstract
Background: Graft infection, in most cases caused by surgical site infection, is a serious complication in arterial operations. Prevention is thought the most effective prophylactic method. After encountering one fatal infection, we changed our strategy for surgical site infections. In this study we evaluated the effect of our new strategy. Methods: We divided 197 patients who underwent graft insertion for arterial disease in our hospital into 2 groups; the pre-group consisting of 101 patients operated before changing our strategy, and the post-group consisting of 96 patients operated on after changing. Our new strategy was; 1) prophylactic antibiotic infusion before the initial skin incision, 2) skin disinfection with chlorhexidine gluconate ethanol, 3) limitation of the use of brushes at the surgical scrub, 4) ample saline washing of the wound before closure, 5) use of a expanded polytetrafluoroethylene graft, 6) film dressing for packing the wound after the operation, and 7) limiting of wound opening after the operation. There were no differences between two groups in terms of age, gender, co-morbidity of diabetes, end stage renal disease, use of steroids, and operative methods. Results: Surgical site infection occurred in 7 cases in the pre-group, whereas there were no infections in the post-group; the incidence being significantly reduced in the post-group by the chi square test. The incidence of infection did not differ with co-morbidity of diabetes, end stage renal disease, use of steroids, and operation-related indices. In the pre-group, hospital death occurred in 7 cases, 3 of these were associated with the wound infection, but while hospital death occurred 4 in the post-group, there were no cases of wound infection (no statistically significantly different). Conclusion: Our new strategy was shown to be functional, producing good results and avoiding surgical site infections in arterial operations. It might also have led to a decrease in the incidence of hospital deaths as well as reducing health care costs associated with treatment of infections.
