This guideline is intended to provide new and updated evidence-based recommendations for the prevention of SSI and should be incorporated into comprehensive surgical quality improvement programs to improve patient safety.

The comprehensive intervention that combined intensified infection control measures with routine rectal surveillance cultures was helpful in reducing the incidence of carbapenem-resistant K. pneumoniae in an intensive care unit where strains producing the carbapenemase KPC were endemic.

Rheumatoid arthritis is an inflammatory condition affecting synovial joints. Without treatment, the underlying inflammatory process leads to joint destruction, pain, deformity, disability and accelerated cardiovascular disease.Disease-modifying antirheumatic drugs will attenuate the inflammation. Their benefits are seen at all stages of the disease, however the best outcomes are achieved when they are used shortly after the onset. Patients with suspected rheumatoid arthritis should be referred promptly.Disease-modifying antirheumatic drugs are often used in combination and can have serious adverse effects. Their safe use requires ongoing monitoring to identify potential adverse events.The risk of infection is increased and vaccination is best given before starting disease-modifying antirheumatic drugs.Chronic inflammation also contributes to an increased risk of myocardial infarction, stroke and death. A Canadian population-based prospective cohort study reported an absolute increase in cardiovascular events of 5.7 per 1000 person-years (95% confidence interval 4.9-6.4) in patients with rheumatoid arthritis compared to those without. 4 The use of disease-modifying antirheumatic drugs (DMARDs) to attenuate the inflammatory process has been shown to prevent joint erosions and reduce pain, cardiovascular morbidity and mortality. 3,5 NomenclatureThe development of targeted monoclonal antibodies and small-molecule kinase inhibitors has widened the therapeutic options in rheumatoid arthritis. Each drug has a proven ability to modify the disease process to varying extents. However, the increase in drugs has thwarted our simple terminology of DMARDs, as the term no longer refers solely to synthetic chemical entities. A new nomenclature has been proposed 6 and applied to the drugs registered in Australia for the treatment of rheumatoid arthritis (see Box).A systematic review and meta-analysis found that corticosteroids reduce demonstrated radiographic erosions. 7 While this effect defines corticosteroids as DMARDs, their toxicity profile makes routine long-term use undesirable. Other infrequently used DMARD therapies include azathioprine, ciclosporine and gold salts.