Infection prevention methodologies for lower extremity total joint arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Health Economics

Background:

• Surgical site infections (SSIs) following total joint arthroplasty (TJA) pose a significant economic burden.
• Despite stabilized infection rates at 1.6%, rising revision procedures will increase overall costs.
• Understanding effective infection prevention is crucial for TJA outcomes.

Purpose of the Study:

• To systematically review and assess the efficacy of pre-, peri-, and post-operative infection prevention strategies in TJA.
• To identify current evidence on infection control measures for total hip and knee arthroplasty.
• To evaluate the impact of various prevention techniques on SSI rates.

Main Methods:

• Systematic literature review prioritizing randomized-controlled trials, national registries, and meta-analyses from the last 5 years.
• Inclusion of all relevant articles addressing infection prevention in TJA.
• Analysis of 71 articles focusing on infection prevention strategies out of 549 total articles.

Main Results:

• Key topics reviewed include CDC recommendations, skin preparation, hair removal, draping, operative attire, OR ventilation, traffic, and antibiotic use.
• Preoperative antiseptic scrubbing shows promise in reducing TJA infection rates.
• Traditional methods like laminar-flow operating rooms and body exhaust suits may potentially increase infection rates.

Conclusions:

• Evidence suggests newer strategies like preoperative antiseptic scrubbing are effective in reducing SSIs in TJA.
• Certain traditional infection control methods may require re-evaluation for their efficacy and potential to increase infection risk.
• Optimizing infection prevention protocols is essential to mitigate the economic and clinical impact of SSIs in TJA.