Infection associated with modern surgical procedures.

In postoperative wound infections due to Escherichia coli, 59%o of the sepsis was caused by ten 0-serotypes. For each serotype, except 06, the frequency of sepsis mirrors the frequency of carriage. Endogenous wound infection: evidence was presented but not discussed. Eleven patients had wound infections due to serotype 06, five were carriers of this serotype at the time of operation. Serotype 06 occurred significantly more frequently in wounds than in carriage specimens. In this study the strains showed enhanced infectivity in wounds. I would like to introduce my talk today with a statement and a subtitle. The statement, 'Postoperative wound sepsis is an infectious disease of multifactorial aetiology.' A more fashionable term would be 'communicable disease'. The incidence in general surgical units ranges from 5%O in a new unit with 40% of the patients in single-bedded rooms. modern theatres and plenum ventilation (Davidson et al., 1971) to 10% in the older types of unit with Nightingale wards, intermittent overcrowding and theatres of poor design. The latter figure refers to the incidence in Professor D. M. Douglas's unit in Dundee. This range is for sepsis with at least some degree of morbidity. The inclusion of minor sepsis doubles these figures. Surgical wound sepsis is important to the individual patient in terms of morbidity and occasionally mortality. Important to the surgeon because the effect of a well-executed operation can be substantially diminished, and a septic wound is potentially a continuous source of cross-infection. Important to us all as doctors and patients because of the considerable additional cost to the National Health Service.