title: Is arthroplasty immediately after an infected case a risk factor for infection?
abstract: BACKGROUND
  It is common practice in many centers to avoid performing a clean case in a room in which an infected procedure has just taken place. No studies of which we are aware speak to the necessity of this precaution.
  
  
  OBJECTIVE
  The purposes of this study were to identify (1) the risk of infection in a group of patients who underwent arthroplasties performed immediately after a first-stage arthroplasty for joint infection; and (2) the risk of superficial and deep infections in these patients compared with a matched group of patients who underwent arthroplasties not performed after an infected surgery.
  
  
  METHODS
  Eighty-three patients (85 arthroplasties) who underwent arthroplasties (primary or revision) immediately after patients with known infections underwent surgery in the same operating room (OR) were analyzed for 12 months after surgery to determine the incidence of infection. They were matched for demographic factors and surgery type with a control group of 321 patients (354 arthroplasties) who underwent surgery in an OR that had not just been used for surgery involving patients with infections. We compared the risk of superficial and deep infections between the groups.
  
  
  RESULTS
  Patients in the study group were not more likely to have infections develop than those in the control group. One patient in the study group (1.17%) and three in the control group (0.84%) had deep infections develop; the infection in the patient in the study group was caused by a different organism than that of the patient with an infection whose surgery preceded in the OR. Two superficial infections (2.35%) were detected in the study group and 17 (4.8%) were detected in the control group.
  
  
  CONCLUSIONS
  With the numbers available, we found that a deep infection was not more likely to occur in a patient without an infection after an arthroplasty that followed surgery on a patient with an infection than in one who had surgery after a clean case. Although sample size was a potential issue in this study, the results may serve as hypothesis generating for future studies.
  
  
  METHODS
  Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors: Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. mn.abolghasemi@yahoo.com
authors: Mansour
authors: M
authors: Abolghasemian
authors: Amir
authors: A
authors: Sternheim
authors: Alireza
authors: A
authors: Shakib
authors: Oleg A
authors: OA
authors: Safir
authors: David
authors: D
authors: Backstein
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D016017:Odds Ratio; D009873:Operating Rooms; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D013997:Time Factors; D016896:Treatment Outcome
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