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Optimize patients to effectively prevent periprosthetic joint infections
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Periprosthetic joint infections can be reduced by optimizing at-risk patients, screening for methicillin-resistant Staphylococcus aureus and properly preparing the skin perioperatively, according to a presentation at the Current Concepts in Joint Replacement 2011 Winter Meeting here.
“It is a known fact the incidence of periprosthetic joint infection is on the rise and, unfortunately, that rise is going to pose many challenges to us in … prevention, diagnosis and treatment,” Orthopedics Today Editorial Board member Javad Parvizi, MD, FRCS, said.
Optimizing patients for surgery to prevent perioperative joint infection (PJI) is essential, he said. This includes treating oral, gastrointestinal, genitourinary, skin and nail infections before surgery. Additionally, patients with uncontrolled diabetes or on anti-inflammatory medications who are at “extreme risk of developing PJI” should not be operated on electively, according to Parvizi.
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Highlighting one take home message, he said, “Skin preparation is very important and, in my opinion, starts at home.”
“Alcohol must be part of the skin preparation; otherwise, your agent will not work,” he said.
Because surgical gloves are a source of contamination, “double gloving is a must during total joint arthroplasty,” Parvizi said.
According to Parvizi’s research, there is no science suggesting that laminar airflow, protective “space suits” and the size and volume of the operating room affects PJI rates. “But what is known is that wound contamination occurs during surgery and this is, the majority of the time, by direct fallout or contact with a contaminated glove or an instrument. The primary source of bacteria in the operating room is the OR personnel,” he said.
In discussing the prevention of PJI, Parvizi noted, “One of the most effective agents in prevention of periprosthetic joint infection and surgical site infection is administration of appropriate and timely perioperative antibiotics. Currently, second-generation cephalosporins remain the most effective agents and they have excellent tissue activity against the majority of organisms, including gram-positive cocci. They have a long half-life and good tissue penetration.”
Reference:
- Parvizi J. Minimizing infection risk: Fortune favors the prepared mind. Paper #37. Presented at the Current Concepts in Joint Replacement 2011 Winter Meeting. Dec. 7-10. Orlando, Fla.
- Disclosure: Parvizi has no relevant financial disclosures.