Prevention of wound sepsis in joint replacement surgery

Prevention of infection in the newer orthopedic procedures that involve implantation of large foreign bodies requires the establishment of routines and a policy of meticulous attention to detail. A careful preoperative examination, including identification of occult infections, is crucial. Then, uninfected patients who are selected for such surgery should receive prophylactic antimicrobial agents. The operating room technique includes rigid traffic control, strict aseptic precautions, protection of instruments from airborne contamination until the procedure is begun, and use of impermeable hoods and large masks by members of the surgical team. An iodophor skin preparation appears to achieve satisfactory skin asepsis. Although the use of unidirectional airflow or ultraviolet light reduces the level of airborne bacteria, these procedures have not been proved to be more effective than meticulous, carefully performed surgery in lowering rates of postoperative wound infection.