The Effect of Antiseptics in the Prophylaxis of Infection in Orthopaedic Surgery

Lüdemann, Martin; Muñoz, Pablo; Wagner, Martin; Malzahn, Uwe; Horas, Konstantin; Heuschmann, Peter U.; Rudert, Maximilian

doi:10.1055/a-0608-5292

Cited by 2 publications

(2 citation statements)

References 33 publications

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“…As this chemical has no associated adverse effects, they concluded that this method is a safe and inexpensive method to reduce the infection rate. However, a clear regimen or procedure cannot be recommended based on the current literature 16. Secondly, an instrument or an implant falling to the ground will increase surgical duration.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Contamination of Orthopaedic Polyethylene Implants, Targeting Devices and Arthroscopes. Experts' Decision Tree and Literature Review

Vautrin¹,

Moerenhout²,

Udin³

et al. 2019

J. Bone Joint Infect.

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Abstract. Introduction Sterility errors during orthopaedic procedures can be stressful for the surgeon or scrub nurse and lead to devastating infectious complications and liability issues. This paper aims to review orthopaedic surgeon practices and propose possible attitudes to adopt.Methods Out of 1023 questionnaires sent, 170 orthopaedic surgeons answered a Volunteer Feedback Template (multiple-choice test) by SurveyMonkey® (San Mateo, CA, USA) anonymously. The survey questioned surgeon's response to a sterility mistake during a standard total knee joint replacement, trauma surgery and arthroscopic procedure. Those “sterility mistake” situations occurred when there was contamination of 1) a sterile polyethylene (PE) 2) a sterile targeting device, and 3) an arthroscope.Results When the definitive PE is contaminated, and if a new definitive PE will only be available 2 hours later, 52% of surgeons would wait for the new definitive PE (p<0.001). In the same situation, if a new PE will only be available in 4 hours, the results showed a significant difference favoring two other options: ”putting a definitive PE one size smaller or bigger with balance adjustment” (31%); and “leaving the provisional PE in the joint, closing the wound and re-operating the patient in the coming days when the definitive PE arrives” (29%) (p<0.001). When the new PE is only available 24 hours later results were 34% and 31%, respectively (p<0.001). In the case of a surgical procedure for a classic intertrochanteric fracture, if the carbon fiber targeting device is contaminated, most surgeons (50%) chose to put the nail without the targeting device and finish the surgery (p<0.001). When the arthroscope is desterilized, 39% of participants would wait until the arthroscope has been sterilized again (approximately 2 hours), while 24% would use another procedure (p<0.001). Sixty-two percent of surgeons would adapt their strategy. No clear trend could be identified in terms of antibiotic treatment following a sterility error.Conclusions There are no established guidelines on how to deal with sterility breaches during surgery and on the antibiotic strategy following the prolonged surgical time resulting from the delay for a new implant. The most common course of action chosen by participating surgeons is detailed in our expert decision tree - if another sterile component is not available within 2 hours - : insertion of another PE size, rescheduling the operation, adapting the surgical technique (for trauma procedures), or soaking the arthroscope in disinfectant solution. As instances of contamination cannot be avoided, it is recommended to have a minimum of two copies of sterile PE implants, arthroscopes or targeting devices readily available before surgery begins-.

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Section: Discussionmentioning

confidence: 99%

Perioperative Contamination of Orthopaedic Polyethylene Implants, Targeting Devices and Arthroscopes. Experts' Decision Tree and Literature Review

Vautrin¹,

Moerenhout²,

Udin³

et al. 2019

J. Bone Joint Infect.

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“…A significant reduction in wound infection rates can be achieved with different antiseptic irrigations prior to wound closure (12). Three other reviews conclude that the available literature shows that the use of intraoperative topical antiseptics is of clinical relevance to prevent infection of orthopedic implants (30)(31)(32). A meta-analysis of 20 studies of instrumented spine surgery showed that topical antibiotics can reduce the risk by threefold, while antiseptic irrigation with povidone-iodine can reduce the risk of wound infection by sevenfold (33).…”

Section: Antisepticsmentioning

confidence: 99%

Prevention of implant-associated spinal infections: the GAID-protocol

Przybyl,

Hegewald

2023

Front. Surg.

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ObjectiveThe purpose of this study is to investigate the efficacy of the GAID-Protocol, a bundle of intra- and postoperative infection prevention measures, to reduce implant-associated infections in patients undergoing posterior spinal fusion with instrumentation. These preventive measures are organized into a protocol that includes recommendations for four critical areas of implant protection (acronym GAID): Gloves, Antiseptics: sodium hypochlorite/hypochlorous acid (NaOCl/HOCl), Implants and Drainage-use in large wounds.MethodsWe performed a single-site retrospective review of cases undergoing posterior spinal fusion with instrumentation for primarily degenerative spinal diseases before and after implementation of the GAID-Protocol that was specifically designed to protect against implant-associated infections. The primary outcome was postoperative wound complications requiring surgical intervention, with a particular focus on infectious spondylitis/discitis.Results230 cases were included: 92 (Group A) before and 138 (Group B) after protocol implementation. Overall, wound complications requiring surgical intervention occurred in 7.6% patients in Group A and in 3.6% patients in Group B (p = 0.2297). Of these, infectious spondylitis/discitis was present in 5.4% in Group A and in none of Group B (p = 0.0096). The ratio of infectious spondylitis/discitis to other wound problems was 71% to 29% in Group A, while it was 0% to 100% in Group B (p = 0.0278). The mean time interval between the first revision surgery for wound complications and hospital discharge was significantly different, 38 days SD 20.3 in Group A and 14.4 days SD 8.6 in Group B (p = 0.0442).ConclusionsIn our study, adherence to the GAID-Protocol resulted in a shift from severe to significantly less severe and easier to treat wound complications. Adoption of the GAID-Protocol might contribute to the reduction of implant-associated infections.

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The Effect of Antiseptics in the Prophylaxis of Infection in Orthopaedic Surgery

Abstract: Although no clear regimen can be recommended, the available literature indicates that the use of intraoperative topical antiseptics is of clinical relevance in preventing infection of orthopaedic implants. Further randomised controlled trials are recommended.

Cited by 2 publications

References 33 publications

Perioperative Contamination of Orthopaedic Polyethylene Implants, Targeting Devices and Arthroscopes. Experts' Decision Tree and Literature Review

Perioperative Contamination of Orthopaedic Polyethylene Implants, Targeting Devices and Arthroscopes. Experts' Decision Tree and Literature Review

Prevention of implant-associated spinal infections: the GAID-protocol

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