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No entry: Joint replacement in progress
We may be overlooking simple strategies to reduce infection in lieu of more complex and costly practices.
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Periprosthetic joint infection appears to be on the increases threats the ultimate success of joint arthroplasty, which is an otherwise incredibly effective surgical procedure. The economic impact of this problem is also enormous, particularly as we head toward uncertain times for the health care in the United States.
Currently, approximately $566 million of health care resources are consumed to treat surgical site infection (SSI) following joint replacement. This number is projected to increase to $1.62 billion by 2020.
The economic and psychological burden associated with SSI has lead to a heightened awareness of the problem among the medical community and governmental agencies. Efforts are being invested to understand the problem better and implement strategies to reduce devastating complications.
A recent study from The Rothman Institute discovered that an operating room door opens 60 times during a primary arthroplasty and 135 times during a revision arthroplasty. Considering the undisputed fact that personnel in the operating room are a major source of bacterial shedding and the direct link between operating room traffic and subsequent infections, the findings are sobering and worrisome.
Javad Parvizi
Although the study did not link operating room traffic with subsequent infections, and the incidence of SSI at our center continues to be below the national average, the study raises an extremely important point. It demonstrates that we may be overlooking simple strategies, like controlling the operating room traffic that have been proven to be effective in the reduction of infection, in lieu of more complex and costly practices, such as implementation of laminar flow rooms or personal protection space suits. The paradox is that laminar flow room is disrupted and becomes ineffective every time the operating room door opens.
One may be inclined to assume that the findings of the study is only applicable to one institution or limited to academic centers with constant flow of visitors, fellows and residents. We would caution against such assumption, and challenge all orthopedic surgeons to implement a strategy that aims to decrease operating room traffic and the potential for subsequent infections.
Matthew S. Austin
As visitors of various centers and volunteer consultants to hospitals with “infection problems,” we can assure you that operating room doors are rarely guarded against unnecessary openings and entries. Having discovered this inconvenient truth, we have implemented strategies that aim to address the issue in our hospitals in an effort to serve our patients better. We have travelled back to Sir John Charnley days when “No entry – Joint replacement in progress” was displayed on the door of every orthopedic operating room.
References:
Andersson AE. Am J Infect Control. 2012;doi:10.1016/j.ajic.2011.09.015.
Panahi P. Clin Orthop Rel Res. 2012;doi:10.1007/s11999-012-2252-4.
For more information:
Javad Parvizi, MD, FRCS, editor of Infection Watch, can be reached at the Rothman Institute, 925 Chestnut St., 5th Floor, Philadelphia, PA 19107; 267-339-3617; email: parvj@aol.com.
Disclosures: Parvizi is a consultant to Zimmer, Smith and Nephew, 3M and Convatec. Austin has no relevant financial disclosures.