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Evaluation of measures to decrease intra-operative bacterial contamination in orthopaedic implant surgery.

B A S Knobben1, J R van Horn, H C van der Mei

  • 1Department of Biomedical Engineering, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.

The Journal of Hospital Infection
|December 14, 2005
PubMed
Summary
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Implementing combined behavioral and systemic changes in operating rooms significantly reduced intra-operative contamination during joint replacement surgery. This led to fewer wound infections and a decrease in deep periprosthetic infections, improving patient outcomes.

Area of Science:

  • Orthopedic Surgery
  • Infection Control
  • Surgical Microbiology

Background:

  • Intra-operative contamination poses a risk for surgical site infections (SSIs) in joint replacement procedures.
  • Previous strategies have focused on individual measures, with varying success in reducing contamination.

Purpose of the Study:

  • To assess the effectiveness of combined behavioral and systemic interventions in reducing intra-operative contamination during total hip or knee replacements.
  • To evaluate the impact of these measures on prolonged wound discharge, superficial SSIs, and deep periprosthetic infections (PPIs).

Main Methods:

  • A prospective study involving 207 total hip or knee replacement procedures.
  • Three groups were monitored: control (original conditions), Group 1 (improved plenum use), and Group 2 (enhanced plenum use, disciplinary measures, and laminar flow system).

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  • Bacterial contamination was assessed via instrument swabs and bone material cultures, with an 18-month follow-up for infection outcomes.

    • Main Results:

    • Intra-operative contamination rates were 32.9% (control), 34.3% (Group 1), and significantly reduced to 8.6% (Group 2).
    • Group 2 demonstrated significant decreases in prolonged wound discharge and superficial SSIs.
    • A trend towards reduced deep PPIs was observed in Group 2, though not statistically significant.

    Conclusions:

    • A combination of systemic and behavioral changes in the operating room environment is highly effective in minimizing intra-operative bacterial contamination.
    • These interventions lead to a significant reduction in superficial surgical site infections and prolonged wound discharge.
    • The implemented strategies show promise in decreasing the incidence of deep periprosthetic infections following joint replacement surgery.