Newer infection prevention techniques , such as preoperative antiseptic scrubbing , are affected and may help reduce the infection rate , while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate
Despite advances in our underst and ing of surgical site infections following total joint arthroplasty , this serious surgical complication continues to represent a substantial economic burden for the patient , the treating institution and the healthcare system .
After increasing for the past decade , infection rates have stabilized at 1.6 % ; however , the total cost is projected to increase with the total number of revision procedures performed .
A Preoperative Decolonization Protocol for Staphylococcus aureus Prevents Orthopaedic Infections
Staphylococcus aureus ( S. aureus ) is an independent risk factor for orthopaedic surgical site infection ( SSI ) . To determine whether a preoperative decolonization protocol reduces S. aureus SSIs , we conducted a prospect i ve observational study of patients undergoing elective total joint arthroplasty ( TJA ) at our institution , with two control groups . The concurrent control group comprised patients of surgeons who did not participate in the intervention study . The preintervention control group comprised patients of participating surgeons who had undergone elective TJA during the year before the study . Patients in the intervention group were screened preoperatively for S. aureus by nasal swab cultures . S. aureus carriers were decolonized with mupirocin ointment to the nares twice daily and chlorhexidine bath once daily for 5 days before surgery . All 164 of 636 participants ( 26 % ) who tested positive completed the decolonization protocol without adverse events and had no postoperative S. aureus SSIs at 1-year followup . In contrast , 1330 concurrent control patients had 12 S. aureus infections . If these infections had occurred in the 26 % of patients expected to be nasal carriers of S. aureus at a given time , the infection rate would have been 3.5 % ( 12 of 345 ) in the control group . In addition , the overall infection rate of the participating surgeons , including nonstaphylococcal infections , decreased from 2.6 % during the preintervention period to 1.5 % during the intervention period , translating to an adjusted economic gain of $ 231,741 for the hospital . The data suggest a preoperative decolonization protocol reduces S. aureus SSIs in patients undergoing TJA.Level of Evidence : Level II , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence
Newer infection prevention techniques , such as preoperative antiseptic scrubbing , are affected and may help reduce the infection rate , while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate
Despite advances in our underst and ing of surgical site infections following total joint arthroplasty , this serious surgical complication continues to represent a substantial economic burden for the patient , the treating institution and the healthcare system .
After increasing for the past decade , infection rates have stabilized at 1.6 % ; however , the total cost is projected to increase with the total number of revision procedures performed .