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Antimicrobial Prophylaxis to Prevent Surgical Site Infection
Joseph Bernstein, MD1; Menachem M. Meller, MD, PhD2
1 Philadelphia Veterans Hospital, 424 Stemmler Hall, University of Pennsylvania, Philadelphia, PA 19104. E-mail address: orthodoc@post.harvard.edu
2 Mercy Hospital Orthopedic Surgery, 501 South 54th Street, Philadelphia, PA 19143
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):1149-1152. doi: 10.2106/JBJS.E.01221
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Antimicrobial prophylaxis reduces the incidence of surgical site infection for many procedures1. Nonetheless, these medications are not always given appropriately2. This failure may stem from a diffusion of responsibility3: both the surgeon and the anesthesiologist may assume that the other has attended to this issue. The root cause, we believe, is the reliance on human action, which invites avoidable error and demands fail-safe routines.To that end, we have incorporated a check on antimicrobial prophylaxis into the "time-out" mandated by the United States Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in the "Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery."4 Our time-out comprises four questions, the first three of which are part of the JCAHO standard:
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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