Journal of Clinical Orthopaedics | Vol 4 | Issue 2 | July-Dec 2019 | page:51-56 | Dr. Anoop C. Dhamangaonkar
Author: Dr. Anoop C. Dhamangaonkar 
 Department of Orthopaedics, LTMGH, Mumbai
Address of Correspondence
Dr. Anoop C. Dhamangaonkar,
Department of Orthopaedics, LTMGH, Mumbai
Surgical site infections are serious complication of any surgery. There are many factors that affect the incidence of surgical site infections and if these factors are understood and controlled to a certain extent, it will help in reducing the incidence of SSIs. In current review, an overview of patient factors, Operative set up and intraoperative precautions are presented which will help in understanding and preventing SSIs.
Keywords: Surgical site infection, Orthoapedics, Prevention.
1. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ: Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008;90(1):62-9.
2. Hikata T, Iwanami A, Hosogane N, Watanabe K, Ishii K, Nakamura M, Kamata M, Toyama Y, Matsumoto M.: High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. J Orthop Sci. 2014;19(2):223-8.
3. Abdallah DY, Jadaan MM, McCabe JP: Body mass index and risk of surgical site infection following spine surgery: a meta-analysis.Eur Spine J. 2013;22(12):2800-9.
4. Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, Sweet FA, Lee DH, RiewKD.Methods to decrease postoperative infections following posterior cervical spine surgery.J Bone Joint Surg Am. 2013 ;95(6):549-54.
5. Thomsen T, Tønnesen H, MøllerAM:Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation.Br J Surg. 2009;96(5):451-61.
6. Klein JD, Hey LA, Yu CS, Klein BB, Coufal FJ, Young EP, Marshall LF, Garfin SR. Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine 1996 ;21(22):2676-82.
7. Hawkins G, Stewart S, Blatchford O, Reilly J. Should healthcare workers be screened routinely for meticillin–resistant staphylococcus aureus? A review of the evidence. J Hosp Infect. 2011;77:285–289.
8. Albrich WC, Harbarth S. Health–care workers: source, vector, or victim of MRSA? Lancet Infect Dis. 2008;8:289–301.
9. Cimolai N. The role of healthcare personnel in the maintenance and spread of methicillin–resistant Staphylococcus aureus. J Infect Public Health. 2008;1:78–100.
10. Danzmann L, Gastmeier P, Schwab F, Vonberg RP. Health care workers causing large nosocomial outbreaks: a systematic review. BMC Infect Dis. 2013;13:98.
11. Mullen A, Wieland HJ, Wieser ES, Spannhake EW, Marinos RS. Perioperative participation of orthopedic patients and surgical staff in a nasal decoloni- zation intervention to reduce staphylococcus spp surgical site infections. Am J Infect Control. 2017;45:554–556.
12. De Lucas–Villarrubia JC, Lopez–Franco M, Granizo JJ, De Lucas–Garcia JC, Gomez–Barrena E. Strategy to control methicillin–resistant taphylococcus aureus post–operative infection in orthopaedic surgery. Int Orthop. 2004;28:16–20.
13. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27:97–132; quiz 133–4; discussion 96.
14. Parvizi J, Cavanaugh PK, Diaz–Ledezma C. Periprosthetic knee infection: ten strategies that work. Knee Surg Relat Res. 2013; 25: 155–64.
15. Tanner J, Norrie P, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2011:CD004122.
16. Rezapoor M, Parvizi J. Prevention of periprosthetic joint infection. J Arthroplasty. 2015;30:902–7.
17. Lefebvre A, Saliou P, Lucet JC, Mimoz O, Keita–Perse O, Grandbastien B, et al. Preoperative hair removal and surgical site infections: network meta– analysis of randomized controlled trials. J Hosp Infect. 2015;91:100–8.
18. Phillips, Nancymarie. Berry & Kohn’s operating room technique. Saint Louis: Elsevier, 2017.
19. Hemani ML, Lepor H. Skin preparation for the prevention of surgical site infection: which agent is best? Rev Urol. 2009;11: 190–5.
20. Markatos K, Kaseta M, Nikolaou VS. Perioperative skin preparation and draping in modern total joint arthroplasty: current evidence. Surg Infect (Larchmt). 2015;16:221–225.
21. Matar WY, Jafari SM, Restrepo C, Austin M, Purtill JJ, Parvizi J. Preventing infection in total joint arthroplasty. J Bone Joint Surg Am. 2010;92 Suppl 2:36–46.
22. Bellchambers J, Harris JM, Cullinan P, Gaya H, Pepper JR. A prospective study of wound infection in coronary artery surgery. Eur J Cardiothoracic Surg. 1999;15:45–50.
23. Garibaldi RA, Maglio S, Lerer T, Becker D, Lyons R. Comparison of nonwoven and woven gown and drape fabric to prevent intraoperative wound contamination and postoperative infection. Am J Surg. 1986;152: 505–9.
24. Webster J, Alghamdi A. Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database of Syst Rev. 2015:CD006353.
25. Blom A, Estela C, Bowker K, MacGowan A, Hardy JR. The passage of bacteria through surgical drapes. Ann R Coll Surg Engl. 2000; 82(6): 405–7.
26. Marvil SC, Tiedeken NC, Hampton DM, Kwok SC, Samuel SP, Sweitzer BA. Stockinette application over a non–prepped foot risks proximal contamina- tion. J Arthroplasty. 2014; 29(9):1819–22.
27. Ritter M a, Eitzen H, French ML, Hart JB. The operating room environment as affected by people and the surgical face mask. Clin OrthopRelat Res.1975:147–50.
28. Weiser M, Shemesh S, Chen D, Bronson M, Moucha C. The effect of door opening on positive pressure and airflow in operating rooms. J Am AcadOrthop Surg. 2018;26:e105–e113.
29. Tanner J, Dumville JC, Norman G, Fortnam M. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database Syst Rev. 2016 Jan 22;(1):CD004288.
30. Markel TA, Gormley T, Greeley D, Ostojic J, Wise A, Rajala J, et al. Hats off: a study of different operating room headgear assessed by environmental quality indicators. J Am Coll Surg. 2017; 225: 573–81.
31. McLure HA, Mannam M, Talboys CA, Azadian BS, Yentis SM. The effect of facial hair and sex on the dispersal of bacteria below a masked subject. Anaesthesia. 2000;55: 173–6.
32. Roxburgh M, Gall P, Lee K. A cover up? Potential risk of wearing theatre clothing outside theatre. J PerioperPract. 2006 Jan;16(1):30-3, 35-41.
33. Breier A–C, Brandt C, Sohr D, Geffers C, Gastmeier P. Laminar airflow ceiling size: no impact on infection rates following hip and knee prosthesis. Infect Control Hosp Epidemiol. 2011;32:1097–1102.
34. Singh S, Reddy S, Shrivastava R. Does laminar airflow make a difference to the infection rates for lower limb arthroplasty: a study using the National Joint Registry and local surgical site infection data for two hospitals with and without laminar airflow. Eur J Orthop Surg Traumatol. 2017;27:261-5.
35. Brandt C, Hott U, Sohr D, Daschner F, Gastmeier P, Rüden H. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg. 2008;248:695–700.
36. Hooper GJ, Rothwell AG, Frampton C, Wyatt MC. Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: the ten–year results of the New Zealand Joint Registry. J Bone Joint Surg Br. 2011;93:85–90.
37. Tayton ER, Frampton C, Hooper GJ, Young SW. The impact of patient and surgical factors on the rate of infection after primary total knee arthro- plasty: an analysis of 64,566 joints from the New Zealand Joint Registry. Bone Joint J. 2016;98–B:334–40.
38. Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect. 1982;3:123–35.
39. Sharp RJ, Chesworth T, Fern ED. Do warming blankets increase bacterial counts in the operating field in a laminar–flow theatre? J Bone Joint Surg Br. 2002;84:486–8.
40. Sessler DI, Olmsted RN, Kuelpmann R. Forced–air warming does not worsen air quality in laminar flow operating rooms. AnesthAnalg. 2011;113:1416–21.
41. Oguz R, Diab–Elschahawi M, Berger J, et al. Airborne bacterial contamination during orthopedic surgery: A randomized controlled pilot trial. J Clin Anesth. 2017;38:160–4.
42. Haeberle HS, Navarro SM, Samuel LT, et al. No evidence of increased infec- tion risk with forced–air warming devices: a systematic review. Surg Technol Int. 2017;31:295–301.
43. Hussein JR, Villar RN, Gray AJ, Farrington M. Use of light handles in the laminar flow operating theatre––is it a cause of bacterial concern? Ann R Coll Surg Engl. 2001;83:353–4.
44. Dalstrom DJ, Venkatarayappa I, Manternach AL, Palcic MS, Heyse BA, Prayson MJ. Time–dependent contamination of opened sterile operating– room trays. J Bone Joint Surg Am. 2008;90:1022–1025.
45. Kaya I, Ugras A, Sungur I, Yilmaz M, Korkmaz M, Cetinus E. Glove perfora- tion time and frequency in total hip arthroplasty procedures. Acta Orthop TraumatolTurc. 2012;46:57–60.
46. Bible JE, Biswas D, Whang PG, Simpson AK, Grauer JN. Which regions of the operating gown should be considered most sterile? Clin OrthopRelat Res. 2009;467:825–830.
47. Abdelaziz H, Zahar A, Lausmann C, Gehrke T, Fickenscher H, Suero EM, et al. High bacterial contamination rate of electrocautery tips during total hip and knee arthroplasty. Int Orthop. 2018. doi:10.1007/s00264–018–3822–1.
48. Givissis P, Karataglis D, Antonarakos P, Symeonidis PD, Christodoulou A. Suction during orthopaedic surgery. How safe is the suction tip? Acta OrthopBelg 2008;74:531–533.
49. Greenough CG. An investigation into contamination of operative suction. J Bone Joint Surg Br. 1986;68:151–153.
50. Davis N, Curry A, Gambhir AK, Panigrahi H, Walker CR, Wilkins EG, et al. Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg Br. 1999;81:886–889.
51. Trikha V, Saini P, Mathur P, Agarwal A, Kumar SV, Choudhary B. Single versus double blade technique for skin incision and deep dissection in surgery for closed fracture: a prospective randomised control study. J Orthop Surg (Hong Kong). 2016;24:67–71.
52. Schindler OS, Spencer RF, Smith MD. Should we use a separate knife for the skin? J Bone Joint Surg Br. 2006;88:382–5.
53. Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J. Longer Operative Time Results in a Higher Rate of Subsequent Periprosthetic Joint Infection in Patients Undergoing Primary Joint Arthroplasty.J Arthroplasty. 2019;34(5):947-953.
|How to Cite this article: Dhamangaonkar A C. Preventive Strategy for Surgical Site Infections in Orthopaedics. Journal of Clinical Orthopaedics July-Dec 2019;4(2):51-56.
(Abstract Full Text HTML) (Download PDF)