Abstract THE DECREASE in the incidence of postoperative incisional sepsis following the adoption of the principles of Lister has not resulted in a further steady decline in this rate as techniques and an efficient sterilization technology were perfected. There has been no improvement in the incidence of sepsis after clean postoperative incisions over the past 20 years despite substantial efforts. It is hardly satisfying to describe the persistence of a low incidence of sepsis as an "irreducible minimum." This "irreducible" rate does not include the sporadic epidemics of postsurgical infections which on investigation can be shown to have an epidemiologic basis. It is the persistent, low, fluctuating rate which follows clean operations in healthy patients presenting year in and year out and which apparently characterizes individual clean operations as studied in several surgical centers.1 No satisfactory explanation exists as to why 2% to 6% of healthy patients develop postoperative incisional References 1. Post-Operative Wound Infections (Table 19) , Ann Surg 160 (Suppl) :42 (Table 19), 1964.Crossref 2. Elek, S.D.: Experimental Staphylococcal Infections in the Skin of Man , Ann NY Acad Sci 65:85, 1956.Crossref 3. Burke, J.F.: Identification of the Sources of Staphylococcus Contaminating the Surgical Wound During Operation , Ann Surg 158:898, 1963.Crossref 4. Miles, A.A.; Miles, E.M.; and Burke, J.F.: The Value and Duration of Defense Reactions of the Skin to the Primary Lodgement of Bacteria , Brit J Exper Path 38:79, 1957. 5. Miles, A.A., and Niven, J.S.F.: The Enhancement of Infections During Shock Produced by Bacterial Toxins and Other Agents , Brit J Exper Path 31:73, 1950. 6. Miles, A.A.; Misra, S.S.; and Irwin, J.O.: The Estimation of the Bactericidal Power of Blood , J Hyg 38:732, 1938.Crossref 7. Finney, D.J.: A Statistical Treatment of the Sigmoid Response Curve , ed 2, New York: Cambridge University Press, 1962. 8. Barnes, B.A., et al: Surgical Sepsis: Analysis of Factors Associated With Sepsis Following Appendectomy (1937-1959) , Ann Surg 156:703, 1962.Crossref 9. Barnes, B.A., et al: Surgical Sepsis: Impressions and Facts , Surgery 46:247, 1959. 10. Fisher, R.A.: Statistical Methods for Research Workers , ed 12, New York: Hafner Publishing Co. Inc., 1954. 11. Post-Operative Wound Infections (Appendix B, Table B-36) , Ann Surg 160 ( (suppl) ): 168, 1964.
Archives of Surgery – American Medical Association
Published: Mar 1, 1966