Strict compliance with wound decontamination and patient preparation protocols is a critical element in reducing surgical site infection (SSI) after knee replacement surgery, according to a study in the December 2018 issue of the American Journal of Infection Control. The authors conducted a prospective cohort study of 1,969 patients who underwent knee replacement surgery at a teaching hospital in Spain between January 1, 2008, and December 31, 2106. Rate of SSI decreased during the study period from 1.8% in 2009 to 0.4% in 2016. Removal of hair and score of 2 or greater on the National Healthcare Safety Network SSI risk index were independently associated with an increase in surgical site infection. Some have posited that removing hair with clippers instead of razors may reduce the risk of cuts and abrasions that can lead to SSI. However, the authors said, risk of infection remained higher with clippers than with no hair removal, supporting the recommendation that hair removal should be avoided unless completely necessary. The results highlight "the necessity of strictly complying with patient preparation protocols and wound decontamination, reducing surgery time, and identifying patients at risk who require comprehensive monitoring," the authors said.

HRC Recommends: SSIs are costly, pose major morbidity and mortality risks for patients, lead to longer hospital stays, and are detrimental to patient recovery after surgery. Strategies to prevent SSIs include antimicrobial prophylaxis, blood glucose control during the immediate postoperative period, maintenance of normothermia, supplemental oxygen administration during and immediately after procedures involving mechanical ventilation, use of alcohol-containing skin prep, and use of surgical safety checklists. Surveillance can help identify SSIs and track progress. Healthcare organizations that offer surgical services or care for postsurgical patients may wish to evaluate their systems and processes for recognizing and diagnosing SSI and coordinating care with other providers.