Antibiotics in Hand Surgery

In most cases, antibiotics are not beneficial before, during, or after surgery of the hand. Antibiotics before surgery are typically only needed in patients with known risk factors or if the procedure has a higher than 1% risk of infection.This is true for most clean and short hand surgery procedures. A clean wound or operation is when the skin that is cut through is normal, intact, and healthy. A clean procedure also means that the operative area has no known inflammation or infection present.

Some of the negatives of using antibiotics prior to surgery include:

• Increased bacterial resistance: This means the antibiotic, when used a lot, becomes less effective. The bacteria can protect itself against the antibiotic.
• Risk for allergic reactions
• Pain from catheter placement or if IV leaks
• Severe diarrhea from a bacterial colitis (clostridia difficile)
• Change to normal skin bacteria
• Increased cost of care without clinical benefit

Antibiotics are typically NOT recommended for the following hand surgeries or conditions:

• Procedures that take less than 2 hours
• Carpal tunnel release
• Ulnar nerve decompression at wrist
• Ulnar nerve decompression and transposition at the elbow
• Mass excision in the hand and finger
• Trigger finger release
• Wrist ganglion excision
• De Quervain’s release
• Finger joint replacement surgery
• Wrist arthroscopy when wires are not inserted to stabilize joints or fractures
• Diabetes
• Well-controlled HIV

Antibiotics may be recommended in these situations:

• When the procedure duration is more than 2 hours
• Wrist or elbow joint replacement
• Use of K wires or other internal fixation
• Complex hand trauma
• Dirty wounds
• Human or animal bite wounds
• Immunosuppression
• Presence of a heart valve replacement
• When the development of infection would have life or limb threatening consequences

However, it is important to note that even when an antibiotic is given, an infection can still occur.

Infections in Hand Surgery

Infections can occur for many reasons. There are bacteria that naturally live on skin. Bacteria mostly live in the mouth, GI tract, and nose of humans. They are found on most surfaces throughout the environment. Fungi and other things can cause a post-operative infection as well, but they are less common. Many times, a postoperative wound infection is caused by the normal bacteria that live on the patient’s skin but gets inside during the surgery. They are often staphylococcus and streptococcus. They can get into the wound during the procedure or after the surgery before the skin seals and heals.

There are some factors that can affect risk for developing an infection after surgery, including:

• Diabetes: For those with diabetes the infection rate increases when HBA1c (a lab test that measures blood sure) is over 7-8 mg/dL.Trying to improve blood sugar before surgery and in the early post-operative period can help reduce infection risk.
• Hypoalbuminemia: Low albumin is a marker of poor nutrition. Low albumin can impact the speed of wound healing and inflammation.Studies have shown that patients with an albumin of <3.5 g/dL experienced infection more often. Improving nutrition before surgery can improve healing after surgery. It is also important to eat a healthy number of calories and amount of protein and have a balanced diet after surgery.
• Smoking: Reducing or quitting smoking can reduce infection risk.
• Procedure duration: Procedures lasting more than 2 hours have higher risk for infection.
• Wound care: Carefully following wound care instructions from your surgeon can reduce infection risk after surgery.

Avoiding Infections in Hand Surgery

To reduce skin bacteria, it can be helpful to shower with an antibacterial soap the day prior to surgery. Skin cleansing is also helpful in the morning on the day of surgery. Whether you are in an office, surgery center, or hospital, the skin is further prepared just before the surgery. The surgical extremity may be wiped, washed, scrubbed and prepared with various topical solutions to further reduce infection risk. If hair removal is necessary, electric clippers are safer than standard razors.

After the skin has been prepared, sterile towels or drapes are applied. The surgeon and staff often wear sterile gowns, gloves, hair coverings, and masks to reduce the risk for infection. Instruments and implants are thoroughly cleaned and sterilized before use.

To ensure the best possible outcome after your hand surgery, work with your hand surgeon to prepare days or weeks ahead.

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© 2023 American Society for Surgery of the Hand.This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand.Find a hand surgeon near you.