Prevention

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