Methods to Prevent Infection

- See: Orthopaedic Infection Menu: and risk factors for TJR infection

- Pre-Admission Considerations:
       
- removal of hardware prior to joint arthroplasty:
                - High incidence of early periprosthetic joint infection following THA with concomitant or previous hardware removal


- Hospital and OR Considerations
        - perioperative oxygen 
        - normothermia
                - Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization..  
        wound management
                  - closed suction wound dressing;
                  - topical antimicrobials  
                         - references:
                                - Decrease in infections with the introduction of mupirocin cream at the peritoneal dialysis catheter exit site.
                                - Interventions for preventing infectious complications in haemodialysis patients with central venous catheters.
                                - Postoperative topical antimicrobial use.
                                - Bacitracin after clean surgical procedures may be risky.
                                - Anaphylactic reaction to bacitracin ointment.
                                - Topical bacitracin ointment is associated with decreased risk of mediastinitis after median sternotomy.
                                - Randomized clinical trial of the effect of applying ointment to surgical wounds before occlusive dressing.
                                - Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment.

                  - suture materials: PDS plus suture (see wound management)
                        - references:
                                - Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis
                                - Comparing wound complication rates following closure of hip wounds with staples or subcuticular vicryl suture:

                 - discontinuation of selected medications:
   
                     - antitumor necrosis factors:
                                 - TNF antagonists and postop complications in patients with inflammatory joint dz undergoing elective ortho surgery.
                                 - Complication rates of 127 surgical procedures performed in RA patients receiving TNF alpha blockers.
                                 - Infectious and healing complications after elective orthopaedic foot and ankle surgery during TFN inhibition therapy.



CISH and Susceptibility to Infectious Diseases



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Sunday, March 10, 2019 9:24 pm