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Class I/Clean Uninfected wound in which no inflammation is encountered and respiratory, alimentary, genital, or uninfected urinary tract is not entered.
Class II/Clean-contaminated
Operative wound in which respiratory, alimentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.
Class III/Contaminated Open, fresh, accidental wounds.
Class IV/ Dirty-infected
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera.
4Confidential. For Internal Use Only.
CDC=Centers for Disease Control and Prevention.
Mangram AJ et al. Am J Infect Control. 1999;27:97-134.
Independent Factors Associated With Increased SSI Risk
•Abdominal operation•Operation lasting >2 hours•Surgical site with wound classification of either contaminated or dirty-infected•All wounds are contaminated; the level of contamination determines the severity or presence of an infection
•Operation performed on patient having ≥3 discharge diagnoses
• The risk of SSI can be generally defined as the amount of bacterial contamination at the site of the infection combined with the virulence, or degree of pathogenicity, of the bacteria in relation to the immune system resistance of the patient
• Staphylococcus aureus is a major pathogen that leads to surgical site infection• There are 4 classes of surgical wound categories• Comprehensive infection-control protocols include dozens of preoperative,
intraoperative, and postoperative components
• SSIs are costly to hospitals and patients: $400 – $30,000• Medicare is restricting the payment of hospital-acquired conditions• SSIs are costly in terms of longer hospitalization and increased mortality for
• High-purity material that meets USP specifications for triclosan, with minimal residue content
• IRGACARE MP is safe• Biocompatible, nontoxic
• Consumer products
• IRGACARE MP is effective• Active against methicillin-sensitive and methicillin-resistant S aureus and S epidermidis (most common for device infections)
• Active against Escherichia coli and Klebsiella pneumoniae
• IRGACARE MP is compatible with suture processing• Maintains excellent suture properties
18Confidential. For Internal Use Only.
USP=United States Pharmacopeia.
Zurita R et al. Macromol Biosci. 2006;6:58-69.
Ming X et al. Surg Infect (Larchmt). 2007;8:201-207.
Ming X et al. Surg Infect (Larchmt). 2008;9:451-457.
•Chlorinated phenolic biocide—a “phenol” with multitargeted biocidal mechanisms•Actions widely unknown•Nonspecific effects on cell membrane activities and cell membrane integrity
•Blocks active site of the enoyl-acyl carrier protein reductase—an essential enzyme in fatty acid synthesis—building cellular components and reproduction
•Well absorbed after oral administration•Well distributed in the body•Rapidly metabolized in liver to the glucuronide/sulfate conjugate•T½=10 to 13 hours
• IRGACARE MP is very effective against S aureus, S epidermidis, and E coli, which are the 3 most important bacteria related to SSIs
• There is no connection between the use of IRGACARE MP and significant antibiotic resistance
• The use of IRGACARE MP may lead to the overall reduction of the antibiotic burden•Decreases the risk of SSIs and the resulting application of stronger antibiotics against SSIs
•The use of IRGACARE MP is not associated with increased bacterial
virulence that raises the antibiotic burden
22Confidential. For Internal Use Only.
Ming X et al. Surg Infect (Larchmt). 2007;8:209-213.
• Objective: Dr Justinger compared the use of Coated VICRYL* Plus Antibacterial (polyglactin 910) Suture with PDS*II (polydioxanone) Suture (loop suture) for the closure of midline laparotomy to evaluate the reduction in wound infections.
• Patients: 2088 operations between October 2004 and September 2006
• Procedures: Abdominal wall closure (midline incision)• Findings: with PDS Suture (loop suture) for abdominal wall
closure, 10.8% of patients with wound infections were detected. The number of patients with infections using Coated VICRYL Plus Suture decreased to 4.9% despite no changes in protocols of patient care.