- 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.