Preoperative
Identify high risk groups
- immunocompromised
- diabetes
- RA
- malnutrition
Urine screen
- check for and treat UTi
Groin, nose, axilla swabs
- for MRSA
- if positive, treat
- need 3 consecutive free swabs
3 x chlorhexidine preoperative showers in 8 hours
Admit day of surgery
- check skin for lesions
- cancel if concern
Intraoperative
Operating room environment
- laminar flow (300 air exchanges per hour)
- minimise staff traffic
Surgeon factors
- space-suit
- double glove / closed glove techniques
- Goretex gown
Wound environment
- preoperative clipping just prior to skin prep
- clipping better than shaving
- alcoholic chlorhexidine
- Waterproof drapes
Antibiotics
- intraoperative dose of antibiotics (Keflin 1g) is most important
- 30 min prior to skin incision
- 5-10 min prior to inflation of tourniquet
- vancomycin / clindamycin if allergic (takes 2 hours infusion)
- repeat if surgery > 2 hour
Surgery
- gentle tissue handling
- minimise surgical time
- use of antibiotic loaded cement / Tobramycin
Postoperative
2-3 doses of antibiotics (Keflin 1g qid)
Skin dressings left intact 4 days
If IDC needed then give prophylactic AB