Infection Prevention and Control

A single patient, forty-eight hours past a sigmoid colectomy that spilled stool before the field could be controlled. The disagreement is over whether the antibiotics he's already receiving are still prophylaxis, four days of treatment for a source-controlled infection, or something the surgeon wants to extend further on comorbidity grounds alone.

A single patient, five days from an elective knee replacement, with a documented MRSA history and a nasal culture that won't return in time to guide the decision either way. The disagreement is whether her own chart already answers the question a pending lab result was supposed to settle.

A single patient, four days into mechanical ventilation for ARDS, in an ICU weighing whether a Dutch mortality trial for selective digestive decontamination applies to a unit with a very different resistance landscape — and to a patient whose own prior culture already carries a resistant organism.

A single patient, about to start six weeks of IV antibiotics for osteomyelitis with two C. difficile recurrences already behind her. The disagreement is whether prophylactic oral vancomycin protects her from a third episode, or trades a real but uncertain benefit for a better-documented cost of its own.

A single patient, fourteen weeks pregnant, a close contact of confirmed meningococcal disease with a ninety-minute drive between her and the agent CDC names for pregnancy — and a disagreement about whether the twenty-four-hour window is a deadline or a target.

A single patient, an hour past a needlestick from a hepatitis B-positive source with no protective antibody of her own. HBIG isn't in question — which vaccine is sitting in the refrigerator tonight is.

A single patient, three hours into a six-hour hernia repair with two liters of unexpected blood loss on the table. The disagreement is whether the clock or the bleeding decides when his antibiotics get redosed — and whether either threshold was built with a patient his size in mind.