Prevention starts with the patient before surgery. Patients are asked to bathe with chlorhexidine the night before surgery and nasal swabs are done during pre op tests to see if the patient is a carrier of staphylococcus aureas, two simple procedures that help ensure a healthy outcome.
The incidence of infection at surgery is small due to intense attempts to control the environment. The introduction of sterile conditions in the surgical suite has its genesis in the mid 1800s when Joseph Lister introduced the idea of hand washing and clean gloves between procedures. British orthopedic surgeon, John Charnley, a pioneer in hip replacement surgery in the 1960s, was the first to use air tents in the operating room to maintain sterile conditions during joint surgery. Tents evolved into modern directional flow air conditioning systems but his concepts are still in place in field hospitals and mobile surgical facilities. In the modern operating theatre staff is kept to a minimum and movement around the room is restricted. A small percentage of people are carriers of staphylococcus aureas and limiting the number of people in the room and their movement reduces the risk of dispersal of staphylococcus in the air. Modern polypropylene theater gowns are most efficient as a barrier to bacterial microorganisms. Paradoxically changing from street shoes or putting on overshoes can result in greater contamination of the surgeon's hands and is not standard. But it's a good idea to wear shoe covers to protect the shoes from blood and fluids. A hood that covers all head hair, including facial hair, reduces the spread of organisms detrimental to the joint replacement patient. All members of the surgical team must wear masks to cover the mouth as bacteria is dispersed from the respiratory tract as we talk. Scrubbing the hands, drying the skin and frequent changes of surgical gloves during the operation is standard. Sterile drapes provide sterile covers for areas away from the surgical site. Prophylactic antibiotics are administered at surgery and post operatively.
As we move on through life our immune system combats bacteria inhabiting our gastrointestinal tract and living on our skin. But bacteria that makes it to the metal and plastic parts of the joint implant are less likely to be vulnerable to our immune response.The most common sources of infection are wounds, other surgical procedures and invasive dental work. People at greatest risk are those with immune deficiencies, diabetes, poor circulation, chemotherapy treatments, and obesity.
Superficial infections can be treated with oral or intravenous antibiotics. Deep and serious infections almost always require surgery. Treatment ranges from debridement to removal of the implanted joint. Prevention is imperative. Be observant and watch for signs of infection: new pain or stiffness, swelling, redness, fevers or chills, wound drainage, or fatigue. Until recently patients were always advised to take a single antibiotic dose prior to dental work. There is now some debate over whether that is necessary.
It seems such a simple thing to do to prevent a possibly disastrous event. I can't imagine why one would not take the precaution. My hospital still recommends it. Check with your doctor or hospital.
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