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Preoperative Infection Control

- Discussion:
   -
risk factors for total joint infections
   - diabetic - sugar - control: (for prevention of infection)
          -
preoperative blood glucose should be less than 125 and postoperative glucose should be less than 200;
          - ref: Preoperative hyperglycemia predicts infected total knee replacement.
   - pre-operative anemia: (anemia work up labs)
          - need to keep Hgb above 12 in females and above 13 in males prior to surgery;
          - references:
                    - Preoperative Anemia in Total Joint Arthroplasty: Is it Associated with Periprosthetic Joint Infection?
                    - Patient-related risk factors for joint infection and postoperative mortality following total hip arthroplasty in Medicare patients.
   - nasal MRSA / MSSA Screening: (CRW editorial page 18-19)
         - preoperative nasal swabs should be mandatory in all patients, and elective surgical patients should be decolonized prior to admission;
         - decolonization methods:
         - bactroban cream - patient information, bactroban for MDs, bactroban maker
         - bacitracin - patients
         - chlorohexidene
         - references:
                - Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients.
                - The role of MRSA screening in joint-replacement surgery.
                - Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control.
                - A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections.
                - Staphylococcus aureus Nasal Colonization in Preoperative Orthopaedic Outpatients.
                - Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.
                - Minimizing Surgical-Site Infections
                - Patient Experience With Mupirocin or Povidone-Iodine Nasal Decolonization

 - Smoking Cessation:
           - Effect of Smoking Cessation Intervention on Results of Acute Fracture Surgery: A Randomized Controlled Trial.
           - Smoking attenuates wound inflammation and proliferation while smoking cessation restores inflammation but not proliferation.
 
- Vitamin D deficiency? (see vitamin D discussion)
       - references:
              - Scientists Find Why 'Sunshine' Vitamin D Is Crucial
              - The antibiotic vitamin: deficiency in vitamin D may predispose people to infection
              - Vitamin D Deficiency Study Raises New Questions About Disease and Supplements
              - Vitamin D deficiency in patients with osteoarthritis undergoing total hip replacement: a cause for concern?

- Preadmission Chlorohexidene Wash:
        - Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty.
        - Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection
        - Seasonality of Infection Rates After Total Joint Arthroplasty
        - Skin preparation before hip replacement in emergency setting versus elective scheduled arthroplasty: bacteriological comparative analysis.