Protocols for the Use of a Novel Biofilm-Disrupting Wound Irrigation Solution for Prevention of Surgical-Site Infections After Total Joint Arthroplasty

2021 ◽  
Vol 39 ◽  
Author(s):  
Paul Knapp ◽  
◽  
Zhongming Chen ◽  
Giles Scuderi ◽  
Michael Mont ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Surgical Site Infections ◽  
Joint Arthroplasty ◽  
Positive Outcomes ◽  
Wound Irrigation ◽  
Effective Prevention ◽  
Total Joint Arthroplasties ◽  
Irrigation Solution ◽  
Joint Arthroplasties ◽  
Prevention Option

Surgical-site infections are potential complications of total joint arthroplasties. Many strategies, ranging from preoperative to postoperative, have been developed in an attempt to mitigate this morbidity. Biofilms have been implicated in difficulties of treatment. Therefore, antimicrobials have been increasingly used to combat these problems. In this report, we will summarize different protocols which utilize a new antimicrobial solution. Providing surgeons with an effective prevention option for these infections is crucial for positive outcomes and the continued advancement in the practice of total joint arthroplasty.

scholarly journals Risk Factors for Infection Following Total Joint Arthroplasty in Rheumatoid Arthritis

2013 ◽  
Vol 7 (1) ◽  
pp. 119-124 ◽  
Author(s):  
Ranjani Somayaji ◽  
Cheryl Barnabe ◽  
Liam Martin
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hospital Admission ◽  
Total Joint Arthroplasty ◽  
Surgical Site Infections ◽  
Joint Arthroplasty ◽  
Increased Risk ◽  
Artery Disease

Objectives: Determine risk factors for infection following hip or knee total joint arthroplasty in patients with rheumatoid arthritis. Methods: All rheumatoid arthritis patients with a hip or knee arthroplasty between years 2000 and 2010 were identified from population-based administrative data from the Calgary Zone of Alberta Health Services. Clinical data from patient charts during the hospital admission and during a one year follow-up period were extracted to identify incident infections. Results: We identified 381 eligible procedures performed in 259 patients (72.2% female, mean age 63.3 years, mean body mass index 27.6 kg/m2). Patient comorbidities were hypertension (43.2%), diabetes (10.4%), coronary artery disease (13.9%), smoking (10.8%) and obesity (32%). Few infectious complications occurred: surgical site infections occurred within the first year after 5 procedures (2 joint space infections, 3 deep incisional infections). Infections of non-surgical sites (urinary tract, skin or respiratory, n=4) complicated the hospital admission. The odds ratio for any post-arthroplasty infection was increased in patients using prednisone doses exceeding 15 mg/day (OR 21.0, 95%CI 3.5-127.2, p=<0.001), underweight patients (OR 6.0, 95%CI 1.2-30.9, p=0.033) and those with known coronary artery disease (OR 5.1, 95%CI 1.3-19.8, p=0.017). Types of disease-modifying therapy, age, sex, and other comorbidities were not associated with an increased risk for infection. Conclusion: Steroid doses over 15 mg/day, being underweight and having coronary artery disease were associated with significant increases in the risk of post-arthroplasty infection in rheumatoid arthritis. Maximal tapering of prednisone and comorbidity risk reduction must be addressed in the peri-operative management strategy.

scholarly journals An operating room audit to examine for patterns of staff entry/exit: pattern sequencing as a method of traffic reduction

2020 ◽  
pp. 175717742096707
Author(s):  
Rachel L Anderson ◽  
Jodi A Lipps ◽  
Carrie L Pritchard ◽  
Aardhra M Venkatachalam ◽  
DaiWai M Olson
Keyword(s):  
Surgical Site Infections ◽  
Sequential Data ◽  
Surgical Incision ◽  
Total Joint Arthroplasties ◽  
Solution Approach ◽  
Single Solution ◽  
Traffic Reduction ◽  
Intraoperative Period ◽  
Significant Patterns ◽  
Joint Arthroplasties

Background: Surgical site infections (SSIs) are estimated at over 16,000 annually and cost hospitals an estimated $1.6 billion per year. Therefore, most operating rooms (ORs) seek methods to reduce the risk of SSI, especially during the intraoperative period. Prior work has established a link between excess traffic through the OR and increased microbial counts, which create a higher risk for SSIs. Aim/Objectives: To identify patterns of staff entry into the OR to further reduce the risk of SSIs after total joint arthroplasties. Methods: Researchers directly observed 31 total joint arthroplasties, recording every instance the door to the OR suite opened and the personnel, reason for opening and timing during surgical incision. Researchers then utilised the sequential data analysis to search for patterns. Results: Despite expected patterns in staff movement during the patterned surgery, researchers found no significant patterns to staff movement during total joint arthroplasty. Discussion: This study’s results suggest purposeful education targeted to circulating registered nurses could induce purposeful creation of traffic flow patterns to further decrease traffic and risk of SSI. Conclusion: There is no singular pattern to entering and exiting the OR during surgery. Thus, a single-solution approach is not recommended.

scholarly journals Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Xingyang Zhu ◽  
Xiaobo Sun ◽  
Yuqing Zeng ◽  
Wenjun Feng ◽  
Jie Li ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Total Joint Arthroplasty ◽  
Meta Analysis ◽  
Bacterial Species ◽  
Surgical Site Infections ◽  
Joint Arthroplasty ◽  
Cochrane Library ◽  
Superficial Infection ◽  
Joint Infections ◽  
The Impact

Abstract Background Nasal Staphylococcus aureus (S. aureus) screening and decolonization has been widely used to reduce surgical site infections (SSIs) prior to total knee and hip arthroplasty (TKA and THA). However, it remains considerably controversial. The aim of this study was to ascertain whether this scheme could reduce SSIs and periprosthetic joint infections (PJIs) following elective primary total joint arthroplasty (TJA). Methods A systematic search was performed in MEDLINE, Embase, and the Cochrane Library until October, 2019. Outcomes of interest included SSI, PJI, superficial infection, and different bacterial species that caused infections. Data from eligible studies were then extracted and synthesized. Pooled odds ratios (OR) and 95% confidence intervals (CIs) were calculated. We also performed additional analyses to evaluate whether there were differences in postoperative SSIs caused by S. aureus or other bacteria. Results Nine studies were included in our meta-analysis. The pooled data elucidated that nasal S. aureus screening and decolonization dramatically mitigated the risk of SSI, PJI, and superficial infection compared to nondecolonization group. The analysis of bacterial species causing infection also showed that the S. aureus infections postoperative were significantly decreased in the decolonization group. However, there was no statistical difference in the SSI caused by other bacteria between the two groups. Conclusion S. aureus screening and decolonization prior to elective primary THA and TKA could significantly decrease the risk of SSI and PJI. However, more robust studies are needed to further evaluate the impact of S. aureus screening and decolonization on infection risk after TJA.

Triple prophylaxis for the prevention of surgical site infections in total joint arthroplasty

2017 ◽  
Vol 28 (1) ◽  
pp. 66-69 ◽  
Author(s):  
Kurt J. Hofmann ◽  
Brett L. Hayden ◽  
Qingwu Kong ◽  
Mary E. Pevear ◽  
Charles Cassidy ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Surgical Site Infections ◽  
Joint Arthroplasty

The Incidence of and Risk Factors for 30-Day Surgical Site Infections Following Primary and Revision Total Joint Arthroplasty

2015 ◽  
Vol 30 (9) ◽  
pp. 47-50 ◽  
Author(s):  
Andrew J. Pugely ◽  
Christopher T. Martin ◽  
Yubo Gao ◽  
Marin L. Schweizer ◽  
John J. Callaghan
Keyword(s):  
Risk Factors ◽  
Total Joint Arthroplasty ◽  
Surgical Site Infections ◽  
Joint Arthroplasty ◽  
Revision Total Joint Arthroplasty

scholarly journals Use of Chlorhexidine Preparations in Total Joint Arthroplasty

2017 ◽  
Vol 2 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Jaiben George ◽  
Alison K Klika ◽  
Carlos A Higuera
Keyword(s):  
Total Joint Arthroplasty ◽  
Biofilm Formation ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Prosthetic Joint ◽  
Hand Antisepsis ◽  
Irrigation Solution ◽  
And Control ◽  
Skin Cleansing ◽  
Emergence Of Resistance

Abstract. Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue. Although chlorhexidine is relatively cheap, routine use of chlorhexidine without evidence of clear benefits can lead to unnecessary costs, adverse effects and even emergence of resistance. This review focuses on the current applications of various chlorhexidine formulations in TJA. As the treatment of PJI is challenging and expensive, effective preparations of chlorhexidine could help in the prevention and control of PJI.

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