Infection Prevention After Orthopedic Surgery

Orthopedic surgery patients have the highest risk of developing a surgical site infection (SSI) after an operation (2). Luckily, the risk of infection after orthopedic surgery can be reduced by following infection prevention measures before, during, and after surgery. These prevention measures include screening surgery candidates for risk factors, properly administering prophylactic antibiotics, and implementing institutional practices for infection prevention.

A crucial first step for infection prevention after orthopedic surgery is thoroughly evaluating orthopedic surgery candidates for modifiable risk factors in the preoperative period. Modifiable risk factors include malnourishment, tobacco and alcohol use, and mental health conditions (1). Identifying these risk factors allows physicians to properly address these issues prior to the procedure.  

Patients who have comorbid conditions such as rheumatoid arthritis, cardiovascular disease, and diabetes also have a higher risk of developing an infection (1). While these risk factors may not be modifiable, evaluating a patient for comorbid conditions allows the patient’s care team to provide specific interventions and lower the risk of infection as much as possible. 

One of the most important measures for infection prevention after orthopedic surgery is the proper administration of prophylactic antibiotics during the procedure. The CDC recommends that prophylactic antibiotics be initiated within one-to-two hours before the surgery begins and continued throughout the procedure (5). Using the proper type of antibiotics for the particular procedure is crucial to this step (5). Furthermore, antibiotics should be discontinued within 24 hours of surgery completion, since administering them for too long can result in antibiotic resistance (5). 

Hospitals and other medical facilities can implement systemized, institutional approaches to prevent infection that are practiced by every care team. Protocols such as hand washing, patient risk assessment, and infection surveillance are likely to be part of this approach (4). Other prevention measures such as shaving the surgical site, nasal decolonization, and monitoring blood glucose levels can also be implemented before, during, or after surgery to minimize infection risk (2). However, antibiotic prophylaxis remains the most important step for preventing SSI. 

Surgical site infections can have lasting consequences for patients, including increased hospital length of stay, higher medical costs, and higher rates of morbidity and mortality (6). SSIs result in around 4 million additional days in the hospital and $2 billion in health care costs annually (5). Considering that orthopedic surgery patients have the highest risk for SSIs, orthopedic surgeons, anesthesiologists, and other care team members involved with orthopedic surgeries should take extra precautions for infection prevention. Taking proper steps preoperatively, intraoperatively, and postoperatively can have a significant effect on ensuring patient safety and promoting fast recoveries. 

References 

1. Antonelli, Brielle and Antonia F. Chen. “Reducing the risk of infection after total joint arthroplasty: preoperative optimization.” Arthroplasty, vol.1, no. 4, 1 Aug 2019. doi:10.1186/s42836-019-0003-7 

2. Copanitsanou, Panagiota. “Recognizing and preventing surgical site infection after orthopaedic surgery.” International Journal of Orthopaedic and Trauma Nursing, vol. 37, May 2020, pp. 100741. doi: 10.1016/j.ijotn.2019.100751 

3. Nagata, Kosei et al. “Effect of Antimicrobial Prophylaxis Duration on Health Care-Associated Infections After Clean Orthopedic Surgery.” JANA Network Open, vol. 5, no. 4, 2022. doi:10.1001/jamanetworkopen.2022.6095 

4. Perry, Kevin and Arlen D. Hanssen. “Orthopaedic Infection: Prevention and Diagnosis.” Journal of the American Academy of Orthopedic Surgeons, vol. 25, pp. S4-S6, Feb 2017. doi:10.5435/JAAOS-D-16-00634  

5. Salkind, Alan R. and Kavitha C. Rao. “Antibiotic Prophylaxis to Prevent Surgical Site Infections.” American Family Physician, vol. 38, no. 5, 2011, pp. 585-590. www.aafp.org/pubs/afp/issues/2011/0301/p585.html 

6. Tucci, G et al. “Prevention of surgical site infections in orthopedic surgery: a synthesis of current recommendations.” European Review for Medical and Pharmacological Sciences, vol. 23, no. 2, 2019, pp. 224-239. doi:10.26355/eurrev_201904_17497