Infection control and prevention is especially difficult for orthopedic surgeons because they are often implanting artificial devices into the patient. "If patients develop an infection, it could mean losing the implant and going back to surgery," says Linda Greene, RN, MPS, CIC, a member of the Association for Professionals in Infection Control and Epidemiology's board and lead author of APIC's Guide to the Elimination of Orthopedic Surgical Site Infections. "Whenever you have an implantable device, one really worries about infection in that population." Ms. Greene discusses six tips orthopedic surgeons to prevent or decrease the risk of infection.
1. Think of the patient as a whole. Instead of just focusing on the patient's knee or hip, think of the patient as a whole and consider all the comorbidities associated with each case. If the patients are diabetic, obese or have glucose control issues, they are at an increased risk of contracting an infection. However, by knowing the patient's history and understanding the increased risk, surgeons can advise their patients on outcomes associated with their comorbidities.
2. Educate the patient sufficiently on infection prevention. Despite following all of the medical guidelines, infections may still occur if the patient doesn't follow infection prevention instructions. Giving patients written instructions increases the chance they will complete the infection control measures, such as the preoperative shower, appropriately. Some organizations offer courses for patients before elective surgery to go through all of the infection control and outcome expectations, says Ms. Greene.
3. Standardize infection prevention processes. Organizations can standardize skin preparations for all surgeons to increase the effectiveness of the infection control process. "The more things we can standardized in healthcare, particularly with surgeries like orthopedic surgeries, the more we can identify when something doesn't go right because we know how it is supposed to go," says Ms. Greene. When there are cases where the patient contracts an infection, have the surgical team gather and examine the case to see what needs to be changed, says Ms. Greene.
4. Make sure pre-operative showers or skin cleansing are done correctly. Patients can decrease the risk of infection by taking a chlorhexidine shower preoperatively. Chlorhexidine reduces the number of microorganisms on the skin and keeps that number down for a certain length of time, so the patient can shower at home before the surgery. However, taking these showers could be difficult for elderly patients or patients with spinal conditions because they may not be able to reach the surgical site.
"Despite the practices' efforts to prevent an infection, execution of these efforts is equally important," says Ms. Greene. "Patients may need to have a family member or nurse apply the chlorohexidine shower or skin wash the night the morning of surgery because we want to make sure we are able to execute these measures in a way that gets the best results."
5. Screen for MRSA. Orthopedic surgeons are starting to screen for MRSA in the patients before surgery, says Ms. Greene. "It's still not solid in the literature, but we've seen a number of studies where people are screening for MRSA and treating the patients to eliminate the possibility of MRSA getting into a joint." Orthopedic surgery is prone to MRSA, so screening for it can decrease the risk of infection.
6. Take a "time-out" before surgery to make sure everyone is on the same page. After the pre-operative work is done and the OR is ready, the surgeon must do a "time-out" with the OR staff to make sure all the pre-operative infection control work is complete, says Ms. Greene. Make sure the patient was given the antibiotic within one hour of surgery, the pre-operative protocols were followed and the appropriate skin preparation was performed and that the prep was allowed to dry before making the incision. Also, also check instruments to assure sterility minimize any risks for cross contamination. "When you think of infections, it isn't one single thing but all of those things taken together," says Ms. Greene. "Orthopedic surgeons are usually dealing with clean surgeries, so they are even more careful than others."
Learn more about APIC.
Read other coverage on orthopedic and spine infection control:
- 6 Best Practices for Implementing an Effective Infection Control Program
- 5 Tips for Improved Infection Control: Dr. Ralph Gambardella of Kerlan-Jobe Surgery Center
- 7 Steps Spine Surgeons Should Take to Prevent Infections
1. Think of the patient as a whole. Instead of just focusing on the patient's knee or hip, think of the patient as a whole and consider all the comorbidities associated with each case. If the patients are diabetic, obese or have glucose control issues, they are at an increased risk of contracting an infection. However, by knowing the patient's history and understanding the increased risk, surgeons can advise their patients on outcomes associated with their comorbidities.
2. Educate the patient sufficiently on infection prevention. Despite following all of the medical guidelines, infections may still occur if the patient doesn't follow infection prevention instructions. Giving patients written instructions increases the chance they will complete the infection control measures, such as the preoperative shower, appropriately. Some organizations offer courses for patients before elective surgery to go through all of the infection control and outcome expectations, says Ms. Greene.
3. Standardize infection prevention processes. Organizations can standardize skin preparations for all surgeons to increase the effectiveness of the infection control process. "The more things we can standardized in healthcare, particularly with surgeries like orthopedic surgeries, the more we can identify when something doesn't go right because we know how it is supposed to go," says Ms. Greene. When there are cases where the patient contracts an infection, have the surgical team gather and examine the case to see what needs to be changed, says Ms. Greene.
4. Make sure pre-operative showers or skin cleansing are done correctly. Patients can decrease the risk of infection by taking a chlorhexidine shower preoperatively. Chlorhexidine reduces the number of microorganisms on the skin and keeps that number down for a certain length of time, so the patient can shower at home before the surgery. However, taking these showers could be difficult for elderly patients or patients with spinal conditions because they may not be able to reach the surgical site.
"Despite the practices' efforts to prevent an infection, execution of these efforts is equally important," says Ms. Greene. "Patients may need to have a family member or nurse apply the chlorohexidine shower or skin wash the night the morning of surgery because we want to make sure we are able to execute these measures in a way that gets the best results."
5. Screen for MRSA. Orthopedic surgeons are starting to screen for MRSA in the patients before surgery, says Ms. Greene. "It's still not solid in the literature, but we've seen a number of studies where people are screening for MRSA and treating the patients to eliminate the possibility of MRSA getting into a joint." Orthopedic surgery is prone to MRSA, so screening for it can decrease the risk of infection.
6. Take a "time-out" before surgery to make sure everyone is on the same page. After the pre-operative work is done and the OR is ready, the surgeon must do a "time-out" with the OR staff to make sure all the pre-operative infection control work is complete, says Ms. Greene. Make sure the patient was given the antibiotic within one hour of surgery, the pre-operative protocols were followed and the appropriate skin preparation was performed and that the prep was allowed to dry before making the incision. Also, also check instruments to assure sterility minimize any risks for cross contamination. "When you think of infections, it isn't one single thing but all of those things taken together," says Ms. Greene. "Orthopedic surgeons are usually dealing with clean surgeries, so they are even more careful than others."
Learn more about APIC.
Read other coverage on orthopedic and spine infection control:
- 6 Best Practices for Implementing an Effective Infection Control Program
- 5 Tips for Improved Infection Control: Dr. Ralph Gambardella of Kerlan-Jobe Surgery Center
- 7 Steps Spine Surgeons Should Take to Prevent Infections