Patient Compliance with Preoperative Disinfection Protocols for Lower Extremity Total Joint Arthroplasty

Infection after total joint arthroplasty has been most attributed to bacterial wound contamination from skin flora. To address this, the CDC recommends bathing with an antiseptic agent the night prior to the operative day. However, despite these measures, the incidence of infections has not been reduced markedly. It is important to have measures in place to ensure proper patient education about infections and disinfection protocols to optimize compliance. Our purpose was to evaluate compliance with preoperative disinfection protocols at our institution and to identify measures which may improve adherence.

Between 2007 and 2011, we reviewed a database at our institution for all patients who underwent primary or revision total hip (n=2,458) and knee (n=2,293) arthroplasty. All of these patients were instructed to follow a chlorhexidine cloth disinfection protocol at the time of surgical scheduling or during their preoperative evaluation. To verify compliance, patients were instructed to remove adhesive stickers from the cloth packages at the time of disinfection and to affix them to the instruction sheet presented on the day of surgery. This was documented in the patient medical records. A database was generated to identify those patients who were compliant (n=1,035) or non-compliant (n=3,716). Following this period, if patients did not use chlorhexidine as instructed, the staff ensured one application was received pre-operatively.

Approximately 78% of patients (3,716 out of 4,751 patients) were noncompliant. When evaluating the demographic between the two groups, we found that age and gender distributions were not significantly different.

While preoperative decolonization protocols may reduce surgical site infections, their efficacy is limited by patient compliance and comprehension. Providing patients with thorough instructions about preoperative disinfection protocols and information about the importance of infection burden is more likely to improve patient adherence.