HAIs are a major public health concern, and the Centers for Disease Control and Prevention (CDC) provides up-to-date information on this issue. It is estimated that 30% of all HAIs in hospitalized patients in the United States are SSIs. An SSI is defined as an infection that occurs at or near a surgical incision within 30 days of the procedure (or within 1 year if an implant was placed). Most SSIs are caused by six types or species of bacteria (Table 5-1). The most common causative agent of SSI is Staphylococcus aureus, which is present in the nose and on the skin of approximately 25% of healthy persons. An SSI is a potential complication of nearly every surgical intervention, particularly because most surgical procedures penetrate the body’s first line of defense: the skin. SSIs may range from minor to serious; they may even be deadly, depending on several factors. Each day in the operating room, surgical technologists vigilantly apply their knowledge of sterile techniques as part of the team effort to prevent SSIs.

Antibiotics are effective tools used to supplement the conscientious practice of sterile techniques. As such, antibiotics are used in surgery (1) to help prevent SSIs and (2) to treat infections caused by bacterial pathogens (disease-causing microbes) (Fig 5-1). It is important to remember that antibiotics are adjuncts that assist the patient’s own defenses to prevent—or diminish the severity of—an SSI. When used to help prevent SSIs, antibiotics may be prescribed for the surgical patient preoperatively, intraoperatively, or postoperatively.

These agents may be administered during surgery from the sterile back table in the form of topical irrigation or application of an antibiotic ointment for surgical dressings. The use of topical antibiotic irrigation at the surgical site has been almost routine in some cases. However, the increase in antibiotic resistance has caused some discussion about the careful use of antibiotics. Further study is ongoing to determine whether this practice is actually effective at reducing SSIs.

The Surgical Care Improvement Project (SCIP) is a quality partnership developed by the Centers for Medicare and Medicaid Services (CMS) and the CDC in collaboration with representatives of several national organizations. One aspect of this project focuses on reducing SSIs, and one of its goals is to increase compliance for proven effective measures related to use of antibiotics, such as: