Prevention of Orthopedic Prosthetic Infections Using Evidence-Based Surgical Site Infection Care Bundles: A Narrative...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Public Health

Background:

• Total joint replacements (TJR) are increasing due to an aging population and comorbidities.
• Revision TJR procedures have significantly higher surgical site infection (SSI) rates (rTKR: 15.6%, rTHR: 8.6%) compared to primary procedures (2.1%-2.2%).
• Orthopedic SSIs lead to prolonged hospital stays, doubled re-admission rates, and a 300% increase in healthcare costs.

Purpose of the Study:

• To review evidence-based practices for reducing SSI risk in TJR.
• To evaluate the impact of surgical care bundles on post-operative outcomes in orthopedic surgery.
• To highlight the importance of a multi-period approach (pre-operative, peri-operative, post-operative) to infection prevention.

Main Methods:

• Systematic literature search of PubMed/MEDLINE, EMBASE, and Cochrane Library (1995-2021) for infection risk and evidence-based practices in TKR and THR.
• Analysis of studies documenting pre-operative, peri-operative, and post-operative interventions.
• Synthesis of evidence on the effectiveness of surgical care bundles in reducing SSIs.

Main Results:

• Evidence-based interventions, including pre-admission CHG cleansing, staphylococcal decolonization, normothermia maintenance, wound irrigation, antimicrobial sutures, and post-operative wound care, improve clinical outcomes.
• Surgical care bundles, while established in other fields, are relatively new but effective in orthopedic surgery.
• These bundles demonstrate significant potential for reducing SSIs, morbidity, mortality, and costs associated with TJR.

Conclusions:

• Evidence-based infection prevention care bundles are effective in improving clinical outcomes across surgical disciplines.
• Implementing comprehensive pre-operative, intra-operative, and post-operative interventions can substantially reduce the morbidity, mortality, and healthcare costs linked to SSIs after TJR.
• Adoption of these bundles is critical for managing the increasing burden of TJR procedures and associated infection risks.