Abstract
Surgical site infections (SSIs) occur in about 1.5 % of Orthopaedic procedures. They are associated with high morbidity and mortality. Risk factors of SSIs have been extensively investigated. Roughly, the risk factors can be divided into: patient-related, surgical procedures -related and operating room environment-related. Patient-related factors are, for example: age, severity of illness, diabetes, obesity, mal-nutrition, smoking, and using of immunosuppressive medications. Surgical procedures-related factors are related to the preparation of the patient and surgical team before the incision, and with surgical duration and techniques. The ventilation and laminar flow in the operating room might also have a role in SSIs. Lastly, the use of peri-operative antibiotic prophylaxis will also influence the risk of having SSIs.
Keywords
- Anterior Cruciate Ligament Reconstruction
- Chlorhexidine Gluconate
- Glove Perforation
- Surgical Scrub
- Adhesive Drape
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278
Pittet D, Harbarth S, Ruef C et al (1999) Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland. Infect Control Hosp Epidemiol 20:37–42
de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB (2009) Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 37:387–397
Astagneau P, Rioux C, Golliot F, Brucker G (2001) Morbidity and mortality associated with surgical site infections: results from the 1997–1999 INCISO surveillance. J Hosp Infect 48:267–274
Emori TG, Gaynes RP (1993) An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 6:428–442
Weigelt JA, Lipsky BA, Tabak YP, Derby KG, Kim M, Gupta V (2010) Surgical site infections: causative pathogens and associated outcomes. Am J Infect Control 38:112–120
Anderson DJ, Kaye KS, Classen D et al (2008) Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 29(Suppl 1):S51–S61
Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH (1993) Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 128:79–88
Jamsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T (2012) Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am 94:e1011–e1019
Dronge AS, Perkal MF, Kancir S, Concato J, Aslan M, Rosenthal RA (2006) Long-term glycemic control and postoperative infectious complications. Arch Surg 141:375–380
Alexander JW, Solomkin JS, Edwards MJ (2011) Updated recommendations for control of surgical site infections. Ann Surg 253:1082–1093
Hugonnet S, Pittet D (2000) Hand hygiene-beliefs or science? Clin Microbiol Infect 6:350–356
Wihlborg O (1987) The effect of washing with chlorhexidine soap on wound infection rate in general surgery. A controlled clinical study. Ann Chir Gynaecol 76(5):263–265
Webster J, Osborne S (2006) Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev. (2):CD004985
Edmiston CE Jr, Krepel CJ, Seabrook GR, Lewis BD, Brown KR, Towne JB (2008) Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission? J Am Coll Surg 207:233–239
Perl TM, Cullen JJ, Wenzel RP et al (2002) Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 346:1871–1877
van Rijen MM, Bonten M, Wenzel RP, Kluytmans JA (2008) Intranasal mupirocin for reduction of Staphylococcus aureus infections in surgical patients with nasal carriage: a systematic review. J Antimicrob Chemother 61:254–261
Jones JC, Rogers TJ, Brookmeyer P et al (2007) Mupirocin resistance in patients colonized with methicillin-resistant Staphylococcus aureus in a surgical intensive care unit. Clin Infect Dis 45:541–547
Tanner J, Norrie P, Melen K (2011) Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev (2);CD004122
Association of Operating Room Nurses (1996) Recommended practices for skin preparation of patients. (abstract) Association of Operating Room Nurses. AORN J 64:813–816
Tschudin-Sutter S, Frei R, Egli-Gany D et al (2012) No risk of surgical site infections from residual bacteria after disinfection with povidone-iodine-alcohol in 1014 cases: a prospective observational study. Ann Surg 255:565–569
Drosou A, Falabella A, Kirsner R (2012) Antiseptics on wounds: an area of controversy. Wounds 15(5):149–166
Edwards PS, Lipp A, Holmes A (2004) Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev (3):CD003949
Darouiche RO, Wall MJ, Jr., Itani KM, et al. Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. The New England journal of medicine. 2010;362(1):18–26.
Werner H (2001) Qualität von OP-Abdeckmaterial und OP-Mäntel. Hyg Med 26:62–75
American Society for Testing Materials (1998) Standard test method for resistance of materials used in protective clothing to penetration by synthetic blood. [abstract] American Society for Testing Materials. ASTM. F1670–1698
Garibaldi RA, Maglio S, Lerer T, Becker D, Lyons R (1986) Comparison of nonwoven and woven gown and drape fabric to prevent intraoperative wound contamination and postoperative infection. Am J Surg 152:505–509
French ML, Eitzen HE, Ritter MA (1976) The plastic surgical adhesive drape: an evaluation of its efficacy as a microbial barrier. Ann Surg 184:46–50
Webster J, Alghamdi AA (2007) Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev (4):CD006353
Jacobson C, Osmon DR, Hanssen A et al (2005) Prevention of wound contamination using DuraPrep solution plus Ioban 2 drapes. Clin Orthop Relat Res 439:32–37
National Collaborating Centre for Womens and Childrens Health (2008) Surgical site infection prevention and treatment of surgical site infection. Ref type: Report
Centers for Disease Control and Prevention (2002) Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA HandHygiene Task Force. Ref type: Report
Jarral OA, McCormack DJ, Ibrahim S et al. Should surgeons scrub with chlorhexidine or iodine prior to surgery? Interactive cardiovascular and thoracic surgery. 2011;12(6):1017–21. Epub 2011/03/03.
Hingst V, Juditzki I, Heeg P, Sonntag HG (1992) Evaluation of the efficacy of surgical hand disinfection following a reduced application time of 3 instead of 5 min. J Hosp Infect 20:79–86
Chen CF, Han CL, Kan CP, Chen SG, Hung PW (2012) Effect of surgical site infections with waterless and traditional hand scrubbing protocols on bacterial growth. Am J Infect Control 40:e15–e17
Duguid JP, Wallace AT (1948) Air infection with dust liberated from clothing. Lancet 2:845–849
Braswell ML, Spruce L (2012) Implementing AORN recommended practices for surgical attire. AORN J 95:122–137
Mitchell NJ, Hunt S (1991) Surgical face masks in modern operating rooms – a costly and unnecessary ritual? J Hosp Infect 18:239–242
Misteli H, Weber WP, Reck S et al (2009) Surgical glove perforation and the risk of surgical site infection. Arch Surg 144:553–558
Laine T, Aarnio P (2001) How often does glove perforation occur in surgery? Comparison between single gloves and a double-gloving system. Am J Surg 181:564–566
Leong G, Wilson J, Charlett A (2006) Duration of operation as a risk factor for surgical site infection: comparison of English and US data. J Hosp Infect 63:255–262
Peersman G, Laskin R, Davis J, Peterson MG, Richart T (2006) Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2:70–72
McHugh SM, Hill AD, Humphreys H (2011) Intraoperative technique as a factor in the prevention of surgical site infection. J Hosp Infect 78:1–4
Tajirian AL, Goldberg DJ (2010) A review of sutures and other skin closure materials. J Cosmet Laser Ther 12:296–302
Gabrielli F, Potenza C, Puddu P, Sera F, Masini C, Abeni D (2001) Suture materials and other factors associated with tissue reactivity, infection, and wound dehiscence among plastic surgery outpatients. Plast Reconstr Surg 107:38–45
Hochberg J, Meyer KM, Marion MD (2009) Suture choice and other methods of skin closure. Surg Clin North Am 89:627–641
Parker MJ, Roberts CP, Hay D (2004) Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 86-A:1146–1152
Clifton R, Haleem S, McKee A, Parker MJ (2008) Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials. Int Orthop 32:723–727
Clifton R, Haleem S, McKee A, Parker MJ (2007) Closed suction surgical wound drainage after anterior cruciate ligament reconstruction: a systematic review of randomised controlled trials. Knee 14:348–351
Kurz A, Sessler DI, Lenhardt R (1996) Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 334:1209–1215
Greif R, Sessler DI (2004) Supplemental oxygen and risk of surgical site infection. JAMA 291:1957–1959
Kabon B, Akca O, Taguchi A et al (2005) Supplemental intravenous crystalloid administration does not reduce the risk of surgical wound infection. Anesth Analg 101:1546–1553
Friberg B (1998) Ultraclean laminar airflow ORs. AORN J 67:841–851
Lidwell OM (1986) Clean air at operation and subsequent sepsis in the joint. Clin Orthop Relat Res (211):91–102
Anderson D, Sexton D (2012) Controversies in control measures to prevent surgical site infection. www.uptodate.com. Accessed on Sep 13, 2012
Brandt C, Hott U, Sohr D, Daschner F, Gastmeier P, Ruden H (2008) Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg 248:695–700
Lynch RJ, Englesbe MJ, Sturm L et al (2009) Measurement of foot traffic in the operating room: implications for infection control. Am J Med Qual 24:45–52
Ayliffe GA (1991) Role of the environment of the operating suite in surgical wound infection. Rev Infect Dis 13(Suppl 10):S800–S804
American Academy of Orthopedic Surgeons (2004) Recommendations for the use of intravenous antibiotic prophylaxis in primary total joint arthroplasty. Ref type: Unenacted Bill/Resolution
Bratzler DW (2001) Osteopathic manipulative treatment and outcomes for pneumonia. J Am Osteopath Assoc 101:427–428
Kalman D, Barriere SL (1990) Review of the pharmacology, pharmacokinetics, and clinical use of cephalosporins. Tex Heart Inst J 17:203–215
Koch CG, Nowicki ER, Rajeswaran J, Gordon SM, Sabik JF III, Blackstone EH (2012) When the timing is right: antibiotic timing and infection after cardiac surgery. J Thorac Cardiovasc Surg 144(4):931–937
French GL (1998) Enterococci and vancomycin resistance. Clin Infect Dis 27(Suppl 1):S75–S83
Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326:281–286
Weber WP, Marti WR, Zwahlen M et al (2008) The timing of surgical antimicrobial prophylaxis. Ann Surg 247:918–926
American Society of Health-System Pharmacists (1999) ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 56:1839–1888
Dettenkofer M, Forster DH, Ebner W, Gastmeier P, Ruden H, Daschner FD (2002) The practice of perioperative antibiotic prophylaxis in eight German hospitals. Infection 30:164–167
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Borens, O., Yusuf, E., Trampuz, A. (2013). Surgical Site Infections (SSIs): Risk Factors and Prevention Strategies. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 13. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36149-4_2
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