Surgical site infections increase total hospital expenses and extend the length of
hospital stay. Properly administered
antibiotics are successful in minimizing postoperative subcutaneous
wound infection secondary to perioperative bacterial contamination at the surgical site and are effective in most clean-contaminated
surgical procedures. It is imperative that therapeutic levels of
antibiotics be present during the time when the
wound is open to maximize their effect to prevent the development of
surgical wound infections. Only 32 per cent of 97 patients sampled from 1992 to 1994 at the Louisville Veterans Affairs Medical Center were administered preoperative
antibiotics within 1 hour prior to
surgical incision. Changing the responsibility for preoperative
antibiotic administration from ward or holding room nurses to the anesthesiologist in the operating room rendered such
antibiotics delivered closer to the induction of
anesthesia and subsequent incision. Eighty-eight per cent of 220 patients sampled in 1995 had
antibiotics administered within 1 hour of incision. This change in institutional policy of
antibiotic administration maximizes the likelihood of appropriate
antibiotic tissue levels and thereby their potential efficacy. Routine prophylaxis should be administered as close to the time of induction of
anesthesia as possible to provide the best chance for appropriate tissue levels above the minimum inhibitory concentration for potential bacterial contamination.