OSE_1309_part3_Layout 1 9/6/13 12:21 PM Page 144
INFECTION PREVENTION
Look at the bigger picture
Diabetics are at high risk for several perioperative events, and
glucose control is only part of the management they need. Routine
pre-op optimization measures are even more important for diabetics.
All surgery results in some contamination of wounds, but as long as
the amount of organisms is minimized and host defenses are adequate, no clinically significant infection occurs. So there are 2 overriding goals:
• Minimize contamination. Timely administration of pre-op antibiotics,
which is a foundation of current perioperative culture, is important,
but it's a double-edged sword. Yes, it does generally reduce risk of
infections, but it also contributes to resistance, so when infections do
occur, they're harder to treat. Hair clipping, as opposed to shaving,
and pre-op showers reduce skin contaminants, although probably not
as much as we'd like.
• Maintain tissue oxygenation. Host defenses are largely dependent on
tissue oxygenation. Anesthesia and the paralysis needed for surgery
slow the metabolism, so limiting the length of surgery as much as possible is important. There's also some evidence that the vasodilation
that accompanies neuraxial anesthesia may reduce SSIs. So here's
something that warrants at least as much attention as glucose control:
If you can get diabetic patients to stop smoking, even a few days
before surgery, that will reverse the vasoconstriction caused by nicotine, and will probably reduce risks as much as any other single measure.
3
Leverage the opportunity
There's never an excuse to ignore short-term glucose control,
but the best approach is to leverage the opportunity to improve
4
1 4 4
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2013
