Journal
of Hospital
Infection
Perioperative
wound orthopaedic
G. J. S. Taylor, Winford
16, 241-247
(1990)
infection surgery
G. C. Bannister
Orthopaedic
Hospital,
Accepted for publication
in elective
and S. Calder Bristol,
11 May
Avon
1990
Summary: Between 1981 and 1987, 12 07 consecutive open elective orthopaedic procedures were performed. The in-patient infection rate was 1.43%. There was a significantly greater risk of infection in revision total knee replacement (15.3%), ankle fusion (9.3%), subtalar fusion (5.8%), primary total knee replacement (5.7%), spinal fusion (5.7%) and revision total hip replacement (4.5%). Revision surgery carried approximately a threefold greater risk than primary procedures. Staphylococci were present in 83% of positive wound cultures. Infection rates varied among surgeons but when number and type of procedure were taken into account only two surgeons differed significantly from that expected. Patients undergoing spinal and hindfoot fusion suffered considerable morbidity as a consequence of wound infection. Antibiotic prophylaxis may be helpful in these procedures. Keywords:
Orthopaedic
surgery;
wound
infection;
audit.
Introduction Despite the widespread use of antibiotic prophylaxis and ultraclean air, infection continues to be a significant hazard in orthopaedic surgery. Accordingly, there has been extensive study of methods to reduce bacterial counts in the operating theatre (Charnley & Eftekar, 1969; Lidwell et al., 1982) and improve host resistance to infection with antibiotic prophylaxis (Ericson, Lidgren & Lindberg, 1973; Hill et al., 1981). Whilst the results of sepsis in joint replacement are well recognized, risks of infection in elective orthopaedic cases which do not involve prosthetic implants have received less attention. There appeared to be a need to discover whether cases other than joint replacement were at substantially increased risk of sepsis, and to assess infection risk in prosthetic surgery in this centre. Materials
and methods
From the beginning of 1981 to the end of 1986, all wound occurring postoperatively in in-patients at Winford Orthopaedic Correspondence Marlborough 019556701/90/070241+07
to: Street,
Mr G. Bristol,
J. S. Taylor, BS2 SHW.
Department
$03.00/O
of
Orthopaedics,
Bristol
infections Hospital, Royal
0 1990 The Hospital
241
Informary,
Infection
Society
242
G. J. S. Taylor
et al.
Bristol were recorded prospectively. The records were compiled by senior medical and nursing staff and detailed the patient, surgeon, procedure, operating theatre, wound culture and grade of infection. Infection was classified as minor if the wound opened superficially but there were no systemic changes and no organisms isolated; as moderate if the infection appeared to be restricted to the superficial region, with or without systemic changes and organisms isolated; and as major if the infection appeared to involve the deeper region, with systemic changes and organisms isolated. Details of the numbers and types of procedures performed and the operating surgeon were obtained from operating theatre records. Antibiotic prophylaxis was used in all prosthetic surgery. Operating theatres were of conventional turbulent flow design.
Statistical
analysis
This employed the Chi-squared considered significant.
test with P values of less than 0.05 being
Results
Of 12 907 open elective orthopaedic procedures performed over the six-year period, sepsis was recorded in 184 cases. This constituted an infection rate of 1.43% Foot surgery formed the greatest workload, accounting for 3 1% of all cases. Total hip replacement formed 21%) total knee replacement 6%) hand surgery 5% and spinal surgery a further 4%. The percentage of wounds 1981-1.47%; 1982-2.17%; infected per annum varied as follows: 1983-0.86%; 1984-0.97%; 1985-070%; and 1986-2.41%. This shows two significant peaks in 1982 (PC 0.01) and 1986 (P
of Hospital
Infection
Perioperative
wound orthopaedic
G. J. S. Taylor, Winford
16, 241-247
(1990)
infection surgery
G. C. Bannister
Orthopaedic
Hospital,
Accepted for publication
in elective
and S. Calder Bristol,
11 May
Avon
1990
Summary: Between 1981 and 1987, 12 07 consecutive open elective orthopaedic procedures were performed. The in-patient infection rate was 1.43%. There was a significantly greater risk of infection in revision total knee replacement (15.3%), ankle fusion (9.3%), subtalar fusion (5.8%), primary total knee replacement (5.7%), spinal fusion (5.7%) and revision total hip replacement (4.5%). Revision surgery carried approximately a threefold greater risk than primary procedures. Staphylococci were present in 83% of positive wound cultures. Infection rates varied among surgeons but when number and type of procedure were taken into account only two surgeons differed significantly from that expected. Patients undergoing spinal and hindfoot fusion suffered considerable morbidity as a consequence of wound infection. Antibiotic prophylaxis may be helpful in these procedures. Keywords:
Orthopaedic
surgery;
wound
infection;
audit.
Introduction Despite the widespread use of antibiotic prophylaxis and ultraclean air, infection continues to be a significant hazard in orthopaedic surgery. Accordingly, there has been extensive study of methods to reduce bacterial counts in the operating theatre (Charnley & Eftekar, 1969; Lidwell et al., 1982) and improve host resistance to infection with antibiotic prophylaxis (Ericson, Lidgren & Lindberg, 1973; Hill et al., 1981). Whilst the results of sepsis in joint replacement are well recognized, risks of infection in elective orthopaedic cases which do not involve prosthetic implants have received less attention. There appeared to be a need to discover whether cases other than joint replacement were at substantially increased risk of sepsis, and to assess infection risk in prosthetic surgery in this centre. Materials
and methods
From the beginning of 1981 to the end of 1986, all wound occurring postoperatively in in-patients at Winford Orthopaedic Correspondence Marlborough 019556701/90/070241+07
to: Street,
Mr G. Bristol,
J. S. Taylor, BS2 SHW.
Department
$03.00/O
of
Orthopaedics,
Bristol
infections Hospital, Royal
0 1990 The Hospital
241
Informary,
Infection
Society
242
G. J. S. Taylor
et al.
Bristol were recorded prospectively. The records were compiled by senior medical and nursing staff and detailed the patient, surgeon, procedure, operating theatre, wound culture and grade of infection. Infection was classified as minor if the wound opened superficially but there were no systemic changes and no organisms isolated; as moderate if the infection appeared to be restricted to the superficial region, with or without systemic changes and organisms isolated; and as major if the infection appeared to involve the deeper region, with systemic changes and organisms isolated. Details of the numbers and types of procedures performed and the operating surgeon were obtained from operating theatre records. Antibiotic prophylaxis was used in all prosthetic surgery. Operating theatres were of conventional turbulent flow design.
Statistical
analysis
This employed the Chi-squared considered significant.
test with P values of less than 0.05 being
Results
Of 12 907 open elective orthopaedic procedures performed over the six-year period, sepsis was recorded in 184 cases. This constituted an infection rate of 1.43% Foot surgery formed the greatest workload, accounting for 3 1% of all cases. Total hip replacement formed 21%) total knee replacement 6%) hand surgery 5% and spinal surgery a further 4%. The percentage of wounds 1981-1.47%; 1982-2.17%; infected per annum varied as follows: 1983-0.86%; 1984-0.97%; 1985-070%; and 1986-2.41%. This shows two significant peaks in 1982 (PC 0.01) and 1986 (P
