Minimizing Infection Risk: Fortune Favors the Prepared Mind

In the last century, an open fracture of the lower extremity would result in amputation and/or death until Joseph Lister described the antiseptic principle. The prepared mind must understand Lister to reduce infection. Lister described washing hands and reducing bacterial counts in the operating room (OR) through clean air techniques. Lister washed his hands, instruments, wounds, bandages, and sprayed carbolic acid to reduce bacteria. Evidence-based medicine supports simple measures, such as limiting OR traffic and personnel, wearing gowns and gloves, and carefully preparing the operative site. Charnley enforced the principles of Lister with laminar flow. OR efficiency and the use of antibiotic cement prevent infection. Data support preoperative antibiotics as the most important factor in reducing infection. Protocols for decolonization reduce infection. The prepared mind focuses on reducing the bacterial count in the OR and uses the host's ability to fight off infection.