The clean air operating room at University Hospitals of Cleveland
The control of infection following surgical procedures has been a major concern since anesthesia permitted operative intervention. Although tremendous progress has been made through aseptic technique, postoperative infections still are a major cause of increased morbidity and disability. A reassessment of further means of reducing the incidence of postoperative infections has been stimulated by the role infection may play in the success or failure of certain surgical procedures that have become possible through advances in surgical technology in recent years. Examples are whole organ allografts, installation of cardiac pacemakers, resections of tumors of the extremities with replacement by prostheses or allografts, total hip replacements and, more recently, total knee replacements. Although surgical techniques have made such procedures feasible, infection as a postoperative complication is a disaster and frequently will lead to total failure of the procedure. This is particularly true when artificial implants are involved.
It has been emphasized by Deryl Hart et al1 as well as by many other investigators that although contamination of the wound at the time of surgery is the primary cause of postoperative wound infection, there are many other factors that influence the incidence of infection. These factors were well documented in the study of an Ad Hoc Committee of the Committee on Trauma of the Division of Medical Sciences, National Academy of Sciences, National Research Council in 1964, and I need only to emphasize that older patients are more prone to postoperative wound infection, as are those patients who are obese, those who are. . .