The epidemic of mad cow disease, centered in the United Kingdom, and associated human cases of variant Creutzfeldt-Jakob disease (Chap. 378) caused by disinfection-resistant prion agents have led to revised recommendations for decontaminating surgical instruments, especially those used for operations on the central nervous system or in patients with dementing illness of unknown etiology. The process of diagnosing and treating wound infections begins with a careful assessment of the surgical site in the febrile postoperative patient. Clinical findings range from obvious cellulitis or abscess formation to subtler clues such as a sternal "click" following open heart surgery. .
