Prevention of operative infections

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The axiom that prevention is the best treatment is especially applicable to infection in hip surgery. The discovery that a joint replacement has become deeply infected is a devastating experience for both patient and surgeon; this usually indicates an immediate or ultimate failure which necessitates surgical intervention and removal of the prosthesis. Despite improvement in sepsis rates, infection remains the major obstacle to achieving successful operative results and patient rehabilitation.

The main modes of surgical infection, direct, airborne, and endogenous, should be considered with relevance to existing preventive measures and controls. Whatever the mode, the immediate postoperative wound provides an excellent locus for development of infection.

Proposed solutions to this problem include: (1) preoperative evaluation to exclude all direct sources of infection and preparation of the local operative site; (2) the use of antistaphylococcal prophylactic antibiotics; (3) evaluation of methods of reducing or eliminating airborne bacteria at surgery; (4) stringent control and reduction of urological procedures, and control of other potential sources of bacteremias and septicemias; (5) early diagnosis and treatment of subcutaneous infection to prevent the involvement of the deep space.

Manifestations and symptoms of infections vary widely and depend on the degree of exposure to infecting organisms, their virulence, and susceptibility of the host, or altered by the degree of obesity or debility, the presence of diabetes or rheumatic arthritis, and steroid therapy.

Good surgical principles that are essential adjuncts of prevention and minimize tissue damage are: excision of devitalized tissue and elimination of dead space, control of . . .