Surgical Infections: Evolving Solutions


Doctor, will I get an infection from surgery? If I do, then what?

This is a question your surgeon never wants to hear, much less have to answer. Why? Because no one knows the answer for sure. Here’s why, and what to do if infection happens.

Infections, fortunately, are uncommon in elective orthopaedic surgery. They happen in 0.1 % to 0.4% of cases, and can usually be treated without long-term consequences.

Sometimes, however, infection leads to a disaster: the loss of the implant or, worse, the loss of a leg [1]. For this reason, infection is feared by both doctor and patient. The randomness of infections, the cost, the loss of work time, the risk to life and limb all drive a maniacal effort to prevent them.

As with much of medicine, there are many interrelated causes of infection [2]. On the surgeon’s side, these causes can be linked to errors in sterilization of equipment, breaks in surgical sterile technique, or failure to recognize unique risk factors the patient may have (such as an immune deficiency, or simultaneous infection in another part of the body) [3].

All of these are avoidable. Checklists have popped up in operating rooms to raise the level of awareness about every single detail that might lead to an infection. Common behaviors of the past–such as too many people in the operating room, or frequent opening and closing of the OR doors–have been virtually eliminated.

On the patient’s side, there are the easy things to control and the impossible ones. Careful pre- and post-operative washing of the skin with Chlorhexidine, a compound found in most antibacterial soaps, has been proved the most effective skin preparation [4]. Preoperative antibiotics timed just 30 minutes before surgery are more effective than antibiotics given long before or —> Read More