The surgeon's responsibility for asepsis

Eighty percent of postoperative wound infections result from bacteria acquired elsewhere than in the operating room. Concomitant infections--such as dermatitis; periodontitis; infections of the respiratory, gastrointestinal, or urinary tracts--are not identified preoperatively, despite a threat to the patient greater than that of anesthesia and surgery combined. Isolation of overt infection is neglected. The entire hospital becomes a reservoir of bacterial debris that is reflected in the carriage of pathogens by personnel and patients. Infections are often initiated by medical devices that invade the vascular system, respiratory tract, or urinary bladder. Professional leadership at the bedside is the key to detecting and correcting breaches in technique and setting an example of a philosophy of total patient care.