An in-hospital workup of a 78-year-old hypeensive, mildly asthmatic man who is receiving chemotherapy for colon cancer reveals symptomatic gallstones. Preoperative laboratory results are notable for a hematocrit of 24% and urinalysis with 18 to 25 WBCs and gram-negative bacteria. On call to the operating room, the patient receives intravenous penicillin. His abdomen is shaved in the operating room. An open cholecystectomy is performed and, despite a lack of indications, the common bile duct is explored. The wound is closed primarily with a Penrose drain exiting a separate stab wound. On postoperative day 3, the patient develops a wound infection. Which of the following changes in the care of this patient could have decreased the chance of a postoperative wound infection?
An in-hospital workup of a 78-year-old hypeensive, mildly asthmatic man who is receiving chemotherapy for colon cancer reveals symptomatic gallstones. Preoperative laboratory results are notable for a hematocrit of 24% and urinalysis with 18 to 25 WBCs and gram-negative bacteria. On call to the operating room, the patient receives intravenous penicillin. His abdomen is shaved in the operating room. An open cholecystectomy is performed and, despite a lack of indications, the common bile duct is explored. The wound is closed primarily with a Penrose drain exiting a separate stab wound. On postoperative day 3, the patient develops a wound infection. Which of the following changes in the care of this patient could have decreased the chance of a postoperative wound infection?
💡 Explanation
**Core Concept**
The patient's postoperative wound infection is a manifestation of a surgical site infection (SSI), which can be caused by various factors including poor wound care, inadequate antibiotic prophylaxis, and contamination during surgery. The risk of SSI can be minimized by implementing evidence-based strategies to reduce bacterial colonization and promote wound healing.
**Why the Correct Answer is Right**
The use of a Penrose drain exiting a separate stab wound increases the risk of wound contamination and infection. This is because the drain provides a conduit for bacteria to enter the wound, especially when the wound is closed primarily. The presence of a drain also leads to increased tissue trauma, which can impair wound healing and increase the risk of infection. Additionally, the use of a separate stab wound for the drain increases the risk of bacterial colonization and contamination.
**Why Each Wrong Option is Incorrect**
**Option A:** Administering intravenous penicillin postoperatively is not sufficient to prevent wound infection, as antibiotic prophylaxis should be initiated preoperatively to be effective. Furthermore, the presence of gram-negative bacteria in the patient's urine suggests that the infection may be polymicrobial, making a single antibiotic agent less effective.
**Option B:** Shaving the patient's abdomen in the operating room may increase the risk of surgical site infection by removing the skin's natural barrier and causing microtrauma to the skin. However, this is not the most direct cause of the patient's wound infection.
**Option C:** Exploring the common bile duct despite a lack of indications may increase the risk of bile leakage and subsequent infection. However, this is not directly related to the patient's wound infection.
**Clinical Pearl / High-Yield Fact**
To minimize the risk of postoperative wound infection, surgeons should use evidence-based strategies such as preoperative antibiotic prophylaxis, meticulous wound care, and closure techniques that minimize tissue trauma.
**Correct Answer:** D.
✓ Correct Answer: B. Treating the urinary infection prior to surgery
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