Prevention of surgical site infection in total joint arthroplasty: an international tertiary care center survey.
BACKGROUND
Prevention strategies are critical to reduce infection rates in total joint arthroplasty (TJA), but evidence-based consensus guidelines on prevention of surgical site infection (SSI) remain heterogeneous and do not necessarily represent this particular patient population.


OBJECTIVE
What infection prevention measures are recommended by consensus evidence-based guidelines for prevention of periprosthetic joint infection? How do these recommendations compare to expert consensus on infection prevention strategies from orthopedic surgeons from the largest international tertiary referral centers for TJA?


METHODS
A review of consensus guidelines was undertaken as described by Merollini et al. Four clinical guidelines met inclusion criteria: Centers for Disease Control and Prevention's, British Orthopedic Association, National Institute of Clinical Excellence's, and National Health and Medical Research Council's (NHMRC). Twenty-eight recommendations from these guidelines were used to create an evidence-based survey of infection prevention strategies that was administered to 28 orthopedic surgeons from members of the International Society of Orthopedic Centers. The results between existing consensus guidelines and expert opinion were then compared.


RESULTS
Recommended strategies in the guidelines such as prophylactic antibiotics, preoperative skin preparation of patients and staff, and sterile surgical attire were considered critically or significantly important by the surveyed surgeons. Additional strategies such as ultraclean air/laminar flow, antibiotic cement, wound irrigation, and preoperative blood glucose control were also considered highly important by surveyed surgeons, but were not recommended or not uniformly addressed in existing guidelines on SSI prevention.


CONCLUSIONS
Current evidence-based guidelines are incomplete and evidence should be updated specifically to address patient needs undergoing TJA.
Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Benjamin F
BF
Ricciardi
Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Mathias P
MP
Bostrom
Department of Orthopedics Clinical Sciences Lund, Lund University, Lund, Sweden ; The Swedish Knee Arthroplasty Register, Lund, Sweden.
Lars
L
Lidgren
Department of Orthopedics Clinical Sciences Lund, Lund University, Lund, Sweden ; National Musculoskeletal Competence Centre, Lund, Sweden.
Jonas
J
Ranstam
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD Australia.
Katharina M D
KM
Merollini
Department of Orthopedics Clinical Sciences Lund, Lund University, Lund, Sweden ; The Swedish Knee Arthroplasty Register, Lund, Sweden.
Annette
A
W-Dahl
infection prevention strategies; international survey; prosthetic joint infection