title: Incidence of surgical site infection in the foot and ankle with early exposure and showering of surgical sites: a prospective observation.
abstract: The incidence of postoperative surgical site infection (SSI) reported in the published data for foot and ankle surgery has been 1.0% to 5.3%. A variety of interventions have been used before, during, and after surgery to decrease the patient's risk of acquiring an infection at the surgical site. Foot and ankle surgeons often keep the incision site dry and covered until the sutures and pins have been removed, with the goal of preventing a SSI, despite the lack of available published evidence to support this practice. We undertook a prospective observation of 110 elective surgical patients to determine the rate of SSI when early surgical site exposure and showering were allowed. The risk factors for infection were recorded, and a series of logistic regression analyses was performed to determine the associations between the infection rate and early showering. The patients were evaluated at each postoperative appointment for signs of infection. For the present study, mild infection was defined as the subjective presence of erythema and/or swelling beyond that typically expected in the early postoperative period. These cases of presumed or mild SSI were managed with oral antibiotics until they had resolved. Major infection was defined as any infection altering the course of recovery or requiring admission or additional surgery. The overall infection rate was 4.5%, with all infections considered mild. Logistic regression analysis showed that none of the recorded risk factors significantly predicted infection. The results of the present study suggest that early daily showering of a surgical site after foot and ankle surgery will not be significantly associated with an increased risk of infection.
authors.affiliation: Assistant Professor, Des Moines University College of Podiatric Medicine and Surgery, Des Moines, IA. Electronic address: Mindi.Feilmeier@dmu.edu.
authors.forename: Mindi
authors.initials: M
authors.lastname: Feilmeier
authors.affiliation: UnityPoint Clinic - Foot and Ankle Fort Dodge, Fort Dodge, IA; and Adjunct Professor, Des Moines University College of Podiatric Medicine and Surgery, Des Moines, IA.
authors.forename: Paul
authors.initials: P
authors.lastname: Dayton
authors.affiliation: Podiatric Medical Student, Des Moines University College of Podiatric Medicine and Surgery, Des Moines, IA.
authors.forename: Shelly
authors.initials: S
authors.lastname: Sedberry
authors.affiliation: Assistant Professor, Des Moines University, Masters of Public Health Program, Des Moines, IA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Reimer
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle / Q000601:surgery*; D005528:Foot / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011184:Postoperative Period; D012307:Risk Factors; D017592:Skin Care; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*
keywords: complications; dressings; infection; postoperative; sutures