Perioperative strategies for decreasing infection: a comprehensive evidence-based approach

Surgical site infections are a devastating complication of orthopaedic procedures and result in increased morbidity and mortality as well as higher costs. Universally, patients with surgical site infections have a worse outcome than uninfected patients. Payers of health care and regulatory organizations, such as the Centers for Medicare and Medicaid Services and the Joint Commission, are demanding both accountability and a reduction in the occurrence of surgical site infections. To effectively prevent such infections, the clinician must address preoperative, intraoperative, and postoperative factors, along with interventions. In the areas where evidence-based literature demonstrates a clear best practice, such as prophylactic antibiotic use and surgical scrub techniques, physicians and health care professionals will be held accountable for compliance with these standards. This accountability will be quantified and will be made available to the public. It is also evident that payers will reward and/or penalize physicians for failure to comply with established standards of care. For the health and safety of patients, surgeons are obligated to become familiar with the known best practices and standards of care with respect to the reduction of surgical site infections.