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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. Study of Wound Infection and Temperature Group.  
        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. A randomized controlled trial.

                  - 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 metallic skin staples or subcuticular vicryl suture: a prospective randomised trial.

                 - discontinuation of selected medications:
                     - antitumor necrosis factors:
                                 - Tumour necrosis factor alpha antagonists and early postoperative complications in patients with inflammatory joint disease undergoing elective orthopaedic surgery.
                                 - Complication rates of 127 surgical procedures performed in rheumatic patients receiving tumor necrosis factor alpha blockers.
                                 - Infectious and healing complications after elective orthopaedic foot and ankle surgery during tumor necrosis factor-alpha inhibition therapy.

CISH and Susceptibility to Infectious Diseases

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