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Preventing Surgical Site Infections: Best Practice Equals Safe Practice

  • Authors: Loren G. Miller, MD, MPH
  • CME/CE Released: 8/25/2010
  • Valid for credit through: 8/25/2011
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Target Audience and Goal Statement

This activity is intended for surgeons, infectious disease specialists, hospitalists, critical care specialists, emergency department physicians, and nurses/nurse practitioners.

The goal of this activity is to provide information on best practices for use by clinicians in the perioperative setting to reduce the rate of surgical site infections (SSIs).

Upon completion of this activity, participants will be able to:

  1. Outline the criteria that are necessary to make a clinical diagnosis of an SSI
  2. Compare the effectiveness of antiseptic agents used for surgical site preparation
  3. Identify evidence-based strategies for preventing SSIs
  4. Select appropriate antibiotic therapy for a patient with an SSI


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Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Loren G. Miller, MD, MPH

    Associate Professor of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California; Director, Infection Control Program, Harbor-UCLA Medical Center, Torrance, California


    Disclosure: Loren G. Miller, MD, MPH, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: Forest Laboratories, Inc.
    Received grants for clinical research from: Pfizer Inc.; Cubist Pharmaceuticals, Inc.

    Dr. Miller does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the US Food and Drug Administration (FDA) for use in the United States.

    Dr. Miller does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor/Nurse Planner

  • Susan L. Smith, MN, PhD

    Scientific Director, Medscape, LLC


    Disclosure: Susan L. Smith, MN, PhD, has disclosed no relevant financial relationships.

CME Reviewer

  • Laurie E. Scudder, DNP, NP

    Accreditation Coordinator, Continuing Professional Education Department, Medscape, LLC; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC; Nurse Practitioner, School-Based Health Centers, Baltimore City Public Schools, Baltimore, Maryland


    Disclosure: Laurie E. Scudder, DNP, NP, has disclosed no relevant financial relationships.

Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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    For Nurses

  • Medscape, LLC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 1.0 contact hour(s) of continuing nursing education for RNs and APNs; 0.25 contact hours are in the area of pharmacology.

    Accreditation of this program does not imply endorsement by either Medscape, LLC or ANCC.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.

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Preventing Surgical Site Infections: Best Practice Equals Safe Practice

Authors: Loren G. Miller, MD, MPHFaculty and Disclosures

CME/CE Released: 8/25/2010

Valid for credit through: 8/25/2011


The following test-and-teach case is an educational activity modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and will then read evidence-based information that supports the most appropriate answer choice. Please note that these questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the case, there will be a short post-test assessment based on material covered in the activity.

Patient History

Stella is a 68-year-old, overweight woman with a body mass index of 29.0 kg/m2. She has type 2 diabetes mellitus, hypertension, and hypercholesterolemia. She has a 10-year history of degenerative joint disease of the right hip. After discussion with her primary care physician and an orthopaedic surgeon, she decided to undergo total replacement of her right hip.

A metallic prosthesis fixed with cement was implanted; the surgical procedure was uneventful. After discharge from the hospital, she began physical therapy to regain physical function. Although her mobility gradually improved, 3 weeks after surgery she began to have discomfort and redness at the surgical incision site. At about the same time, she began to experience fatigue and mild sweats, but she did not have a fever. Thinking that she had overexerted herself, she decreased her physical activity, hoping that the discomfort would improve. However, the redness increased and the discomfort persisted. In addition, she noticed that her clothing overlying the incision was damp.

Stella was seen by her primary care physician, who noted that she was afebrile with normal vital signs. On examination, the surgical site was mildly tender to touch, warm, erythematous, and nonfluctuant. There was a small area of dehiscence (Figure 1) from which a small amount of yellow-green discharge was manually expressed.

Figure 1. Suppurative skin lesion showing surrounding erythema and dehiscence.

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