Normeditec

Prevention of Periprosthetic Infections: Addressing Hidden Risks

Periprosthetic infections remain one of the most severe complications following knee and hip arthroplasty, with the majority only becoming evident after hospital discharge. According to data from Switzerland (Staszewicz et al. 2014, Troillet et al. 2017), 80% of wound infections for hip prostheses and 95% for knee prostheses are detected post-discharge. This suggests that if infection rates are only recorded in-house, the actual infection rates may be at least 80% higher than reported.

Understanding the True Source of Infections

Contrary to common assumptions, bacteria do not primarily enter the wound via the air; the likely culprits are contaminated instruments.

Key Questions:

• Would you open a prosthesis at the start of an operation?
  Any surgeon would firmly say “no,” emphasizing the need to open artificial hip or knee prostheses at the last possible moment to prevent contamination.
• How long have the instruments used to insert the prosthesis been exposed?
  Instruments left unprotected during surgery are a critical source of contamination, increasing the risk of infection.

The Reality of Operating Rooms

While many believe that operating rooms (ORs) are ultra-clean, even sterile environments, professionals know this is far from the truth.

Factors Increasing OR Contamination:

• Human Presence:
  Every person entering the OR introduces pathogens into the environment, significantly increasing contamination levels. The more people present, the higher the risk.
• Continuous Particle Shedding:
  Despite wearing surgical clothing, each person releases 200 to 500 bacteria per minute into the OR environment (Hyg + Med, 1987). These particles can settle on surfaces, including instruments, and contribute to infections.

The Need for an Aseptic Environment

Certain procedures, such as implant surgery and eye surgery, require an extremely aseptic environment, as even minimal contamination can lead to devastating and costly infections.

Key Takeaways for Infection Prevention

1. Sterile Instrument Protocols: Instruments used in surgery must be continuously protected to prevent contamination.
2. Enhanced OR Hygiene: Measures to reduce particle shedding and contamination in the OR are essential, especially for high-risk surgeries.
3. Comprehensive Monitoring: Infection rates should include post-discharge data to provide an accurate understanding of risks and outcomes.

Investing in Preventative Solutions

Modern surgical practices must address the hidden risks posed by instrument contamination and OR environment management. Adopting innovative tools and strict protocols can significantly reduce infection rates, protect patients, and lower the financial burden on healthcare systems.