Here are five ways to decrease infections in orthopedic cases.
1. Make sure pre-operative showers or skin cleansing are done correctly. Patients can decrease the risk of infection by taking a chlorhexidine shower preoperatively. Chlorhexidine reduces the number of microorganisms on the skin and keeps that number down for a certain length of time, so the patient can shower at home before the surgery. However, taking these showers could be difficult for elderly patients or patients with spinal conditions because they may not be able to reach the surgical site.
"Despite the practices' efforts to prevent an infection, execution of these efforts is equally important," says Linda Greene, RN, MPS, CIC, a member of the Association for Professionals in Infection Control and Epidemiology's board and lead author of APIC's Guide to the Elimination of Orthopedic Surgical Site Infections. "Patients may need to have a family member or nurse apply the chlorohexidine shower or skin wash the night the morning of surgery because we want to make sure we are able to execute these measures in a way that gets the best results."
2. Advise obese patients not to diet before surgery. Orthopedic surgeons are seeing a huge increase in the number of total knee and hip replacements in obese patients. These patients are at an increased risk of infection and they must be managed differently from other patients. "It's very important to counsel obese patients preoperatively on several things," says Calin Moucha, MD, associate chief of joint replacement and assistant professor at Mount Sinai Medical Center in New York City. "Tell them not to go on a diet right before surgery because they could become malnourished. When people diet they can go into a catabolic state, which isn't good for an elective procedure." Surgeons also need to work closely with the anesthesiologist preoperatively to make sure the antibiotic dosage is appropriate. Patients who are overweight will need a higher dosage than patients who have a healthy body mass index.
Identifing malnourished patients and making sure they receive help before surgery is also important. Malnourished bodies can't heal wounds, which means making an incision in an undernourished patient could be risky. Elderly patients, especially those with arthritis, are at risk because they may have trouble accessing food. Patients with a history of alcoholism or other chronic illnesses, such as kidney failure, may also be malnourished. "These patients need to be tested before surgery so we can optimize their outcomes," says Dr. Moucha. Blood tests can help the surgeon assess the patient's nutrition when a problem is suspected.
3. Test revision surgery patients for previous infections. There are patients who return after receiving multiple surgeries because they are still experiencing pain. "Every time you re-operate on a patient, the risk of infection is higher," says Dr. Moucha. "You need to test patients with previous surgery to make sure they aren't coming to you with an infection." If a patient with a fracture that isn't healing, they need screws and rods put in or a total joint replacement. Sometimes, the fracture isn't healing because of an infection.
4. Screen for MRSA. Orthopedic surgeons are starting to screen for MRSA in the patients before surgery, says Ms. Greene. "It's still not solid in the literature, but we've seen a number of studies where people are screening for MRSA and treating the patients to eliminate the possibility of MRSA getting into a joint." Orthopedic surgery is prone to MRSA, so screening for it can decrease the risk of infection.
5. Use a multidisciplinary approach. A multidisciplinary approach to treating and preventing deep surgical site infections for orthopedic patients can reduce the common SSIs among joint replacement surgeries, according to a Medscape Medical News report.
The study suggests:
• Develop a skin-site preparation procedure that incorporates chlorhexidine gluconate-based skin antiseptic
• Provide patient education about bathing in CHG before surgery
• Standard the process and addition of vancomycin to the preoperative antibiotic regimen
• Refresh training opportunities for operating room staff on antiseptic technique, sterility and standardization of skin-site preparation
After implementing these initiatives for 12 months, the researchers reported a 66 percent reduction in hip arthroplasty D-SSI and an 80 percent reduction in knee D-SSI.
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"Despite the practices' efforts to prevent an infection, execution of these efforts is equally important," says Linda Greene, RN, MPS, CIC, a member of the Association for Professionals in Infection Control and Epidemiology's board and lead author of APIC's Guide to the Elimination of Orthopedic Surgical Site Infections. "Patients may need to have a family member or nurse apply the chlorohexidine shower or skin wash the night the morning of surgery because we want to make sure we are able to execute these measures in a way that gets the best results."
2. Advise obese patients not to diet before surgery. Orthopedic surgeons are seeing a huge increase in the number of total knee and hip replacements in obese patients. These patients are at an increased risk of infection and they must be managed differently from other patients. "It's very important to counsel obese patients preoperatively on several things," says Calin Moucha, MD, associate chief of joint replacement and assistant professor at Mount Sinai Medical Center in New York City. "Tell them not to go on a diet right before surgery because they could become malnourished. When people diet they can go into a catabolic state, which isn't good for an elective procedure." Surgeons also need to work closely with the anesthesiologist preoperatively to make sure the antibiotic dosage is appropriate. Patients who are overweight will need a higher dosage than patients who have a healthy body mass index.
Identifing malnourished patients and making sure they receive help before surgery is also important. Malnourished bodies can't heal wounds, which means making an incision in an undernourished patient could be risky. Elderly patients, especially those with arthritis, are at risk because they may have trouble accessing food. Patients with a history of alcoholism or other chronic illnesses, such as kidney failure, may also be malnourished. "These patients need to be tested before surgery so we can optimize their outcomes," says Dr. Moucha. Blood tests can help the surgeon assess the patient's nutrition when a problem is suspected.
3. Test revision surgery patients for previous infections. There are patients who return after receiving multiple surgeries because they are still experiencing pain. "Every time you re-operate on a patient, the risk of infection is higher," says Dr. Moucha. "You need to test patients with previous surgery to make sure they aren't coming to you with an infection." If a patient with a fracture that isn't healing, they need screws and rods put in or a total joint replacement. Sometimes, the fracture isn't healing because of an infection.
4. Screen for MRSA. Orthopedic surgeons are starting to screen for MRSA in the patients before surgery, says Ms. Greene. "It's still not solid in the literature, but we've seen a number of studies where people are screening for MRSA and treating the patients to eliminate the possibility of MRSA getting into a joint." Orthopedic surgery is prone to MRSA, so screening for it can decrease the risk of infection.
5. Use a multidisciplinary approach. A multidisciplinary approach to treating and preventing deep surgical site infections for orthopedic patients can reduce the common SSIs among joint replacement surgeries, according to a Medscape Medical News report.
The study suggests:
• Develop a skin-site preparation procedure that incorporates chlorhexidine gluconate-based skin antiseptic
• Provide patient education about bathing in CHG before surgery
• Standard the process and addition of vancomycin to the preoperative antibiotic regimen
• Refresh training opportunities for operating room staff on antiseptic technique, sterility and standardization of skin-site preparation
After implementing these initiatives for 12 months, the researchers reported a 66 percent reduction in hip arthroplasty D-SSI and an 80 percent reduction in knee D-SSI.
Related Articles for Orthopedic Surgeons:
7 Points for Orthopedic Practices Taking On a New Physician Partner
How to Solve Cash Flow Issues: 5 Things for Orthopedic Surgeons and Practices to Know
5 Tips for Orthopedic Practices to Expand Their Patient Base