Hair removal

• Razors can rapidly remove hair from the surgical field, but may result in small cuts and abrasions. This minor skin damage can provide an area where bacterial flora can multiply and potentially infect the surgical incision site.
• Clippers mechanically trim the hairs close to the skin, effectively removing it from the field, and avoid the skin trauma caused by the sharp blade of a razor.
• Depilatory creams remove hair via chemical means, although these are costly and may cause a sensitivity reaction at the site.
• Removing hair immediately before surgery may decrease infection rates.
• A recent Cochrane Review found no statistically significant effect on surgical site infection (SSI) rates of hair removal. However the low numbers involved do not allow confidence in a conclusion.
• When it is necessary to remove hair, clippers are associated with fewer SSIs than razors. There was no significant difference in SSI rates between depilatory creams and shaving, or between shaving or clipping the day before surgery or on the day of surgery.⁸

Antibiotics

• Prophylactic antibiotics purpose: preventing infection when infection is not present but the risk of postoperative infection is present. The goal of antimicrobial prophylaxis is to achieve serum and tissue drug levels that exceed, for the duration of the operation, the minimum inhibitory concentration for the organisms likely to be encountered during the operation.
• Current AAOS guidelines for antibiotics in total joint replacement recommend:
• The antibiotic used for prophylaxis should be carefully selected, consistent with current recommendations in the literature, taking into account the issues of resistance and patient allergies.
  • Usually cefazolin or cefuroxime. Clindamycin or vancomycin may be used for patients with a confirmed beta-lactam allergy. Vancomycin may be used in patients with known MRSA colonisation.
  • Timing and dosage of antibiotic administration should optimise the efficacy of the therapy.
    • Prophylactic antibiotics should be administered within one hour prior to skin incision.
    • Duration of prophylactic antibiotic administration should not exceed the 24-hour postoperative period.
      • http://www.aaos.org/about/papers/advistmt/1027.asp

Figure 3.Prophylatic antibiotics 

Glycaemic control

• Poor peri-operative glycaemic control is associated with higher rates of SSIs, as well as other complications.
• This is thought to be a result of impaired granulocyte function associated with poorly controlled diabetes.^9–13

Body exhaust suits

• These have been shown to decrease infection rates and bacterial air contamination when compared with conventional theatre gowns.^14,15
• Although there is some evidence to suggest that they may not be that effective. This may be due to the suits disrupting the laminar flow, or from inadvertent contamination from light handles or other theatre equipment.¹⁶