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Operating Room Hygiene

- hand washing:
On Washing Hands
       - Images in clinical medicine. The hands give it away.

- antibiotics:
- prophylactic antibiotics : local antibiotic delivery
- skin prep agents
       - Rush Betadine Lavage Protocol:
               - preparation of solution:
               - scrub nurse draws up 17.5cc of 10% povidone-iodine with a syringe and mixes it with 500cc of sterile normal saline;
               - this results in a dilution of 0.35% povidone-iodine for use prior to wound closure;
               - following implantation of the prosthetic components, the wound is soaked with 500cc of the dilute betadine solution for three minutes,
                          followed by pulsatile lavage with 1L of normal saline without antibiotics;
               - prior to final closure, betadine is applied to the skin surrounding the incision;
               - references:
                          - Dilute betadine lavage a simple, less expensive way to reduce postoperative TKA infection
                          - Dilute Betadine Lavage in the Prevention of Postoperative Infection
                          - Dilute Betadine Lavage Before Closure for the Prevention of Acute Postoperative Deep Periprosthetic Joint Infection

- nurse and surgeon hygiene
      - glove perforation: 
              - double gloving with each glove having a different color (shows perforation):
ioban strips are wrapped around each wrist;
              - references:
                      - Glove perforation in pediatric orthopedic practice.
                      - Glove perforation in ortho and trauma surgery. A comparison between single, double indicator gloving and double gloving with two regular gloves.. 
                      - Glove perforation and contamination in primary total hip arthroplasty
                      - Clinical performance of latex free gloves- Is it safe for arthroplasty surgery?
                      - Unsuitability and high perforation rate of latex-free gloves in arthroplasty: a cause for concern
                      - Comparison of glove donning techniques for the likelihood of gown contamination. An infection control study
      - surgical gown:
             - references:
                      - Which Regions of the Operating Gown Should be Considered Most Sterile?
                      - Body-exhaust suit versus occlusive clothing. A randomised, prospective trial using air and wound bacterial counts. 
                      - The Gown-glove Interface Is a Source of Contamination: A Comparative Study
      - mask:
             - Molecular epidemiology of microbial contamination in the operating room environment: Is there a risk for infection?

- operating room hygiene:
      - trays are not opened until surgery is ready to begin;
      - minimize use of nitrogen driven equipment;
      - environmental swabbing on a regular basis;
      - flashing instrument tray:
in the study by Sechriest et al (JBJS May 2013) flashing of ACL instrument trays was associated with 35% of infections;
              - Incidence of Knee Sepsis After ACL Reconstruction at One Institution: The Impact of a Clinical Pathway.

- plastic adhesive drapes:
       - Plastic adhesive drapes and wound infection after hip fracture surgery
       - Use of plastic adhesive drapes during surgery for preventing surgical site infection

- splash basins:
             - Is Repetitive Intraoperative Splash Basin Use a Source of Bacterial Contamination in Total Joint Replacement?

- references:

- Intraoperative Contamination Influences Wound Discharge and Periprosthetic Infection.
- Unnecessary hospital infection control practices in Thailand: a survey.
- [The hygienic significance of operating lights].
- Transfer of bacteria between biomaterials surfaces in the operating room--an experimental study.
- Microbial colonization of tourniquets used in orthopedic surgery.
- Perioperative contamination in primary total hip arthroplasty.
- Time-Dependent Contamination of Opened Sterile Operating-Room Trays
- Potential for infection in orthopaedic practice due to individually packaged screws
- Potential for contamination of orthopaedic implants using individually wrapped screws
- Berry and Kohn's Operating Room Technique
- Positive Intraoperative Cultures and Canine Total Hip Replacement: Risk Factors, Periprosthetic Infection, and Surgical Success
- Current concepts for clean air and total joint arthroplasty: laminar airflow and ultraviolet radiation: a systematic review.
- Intraoperative subcutaneous wound closing culture sample: a predicting factor for periprosthetic infection after hip- and knee-replacement?
- Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation.