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Pets, obesity and nurses: surgical site infections in the community

02 May 2024
Volume 29 · Issue 5


Many surgical site infections (SSI) emerge after the patient is discharged from hospital. So, practice and district nurses should remain alert for SSIs and address modifiable risk factors, which include helping obese patients lose weight, optimising glucose control in people with diabetes and encouraging smoking cessation. Animals, including pets, are important reservoirs of resistant bacteria. By optimising SSI care, nurses can not only improve wound healing but also help preserve antibiotic efficacy.

Medieval barber-surgeons operated with primitive instruments and without anaesthesia or aseptic technique, let alone effective antibiotics. Popular medieval wound dressings included ground rabbit fur and powders made from the remains of Egyptian mummies. Not surprisingly, postoperative mortality reached 60–80% usually from ‘hospital’ (Streptococcal) gangrene (Smith et al, 2012).

Instruments and techniques improved over the centuries. The famous Victorian surgeon Robert Liston could amputate and suture a leg in about 30 seconds. Liston's postoperative mortality rate, based on 66 amputations he performed at University College London Hospital between 1835 and 1840, was 1 in 6. Around the same time, mortality following amputations was 1 in 4 at St Bartholomew's Hospital (Thomas, 2012).

Liston also holds an unenviable record: a 300% mortality rate after one amputation. In addition to the patient's leg, Liston amputated his assistant's fingers. The assistant and patient died from infection. Liston also sliced through an observer's coat tails. The man thought Liston had cut him and died from shock (Thomas, 2012).

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