Avoiding infection before, during, after orthopedic surgery

8/19/2019 by Lori McGowan, PA-C

ECH_SurgicalAntibotic_widget

Infection after an orthopedic surgical procedure can be draining physically, mentally, emotionally and financially. If you're scheduled for orthopedic surgery, you can help reduce your own risk of infection. Your orthopedic health care team also makes every effort to prevent infection by following Mayo Clinic's and the Center for Disease Control's (CDC) best practice care guidelines before, during and after surgery. 

What to do before surgery

Your surgeon may advise you to attend a pre-surgery class where you'll learn about measures to prevent infection, including: 

  • Staying healthy! Work with your health care team to make sure your health is the best it can be before surgery. this is particularly relevant in cases of: 
    • Obesity. Extra body weight increases the risk of infection.
    • Diabetes. Infection risk is increased, particularly with poorly controlled diabetes, reflected in high hemoglobin A1C levels. 
    • Malnutrition. Individuals at higher infection risk include those with metabolic conditions or after gastric bypass surgery. 
    • Recurrent infections. Chronic urinary tract infections are the most common. 
  • If you smoke, try to stop. Smoking inhibits healing and increases the risk of infection. Your health care team may recommend postponing your surgery until you haven't been smoking for several weeks. You shouldn't smoke during your recovery, either. Blood work may be used to confirm that you're off nicotine products. 
  • Reduce bacteria in your body. The night before and the morning of surgery, you'll use a special soap to thoroughly wash off bacteria regularly found on your skin. Before shoulder surgery, you may also need to wash with benzoyl peroxidase, which is particularly effective at clearing Cutibacterium acnes, a bacteria present on the chest, back and armpit. You may carry staphylococcus in your nose; an antiseptic solution may be used to decontaminate it just before surgery. 
  • Taking a medication break. You may be asked to take a break from certain medications before, during and after surgery. These can include blood thinners, anti-inflammatories and immunosuppressive medications. Talk to your health care team before taking a break from any of your medications. 

Antibiotics during surgery

Your health care team will administer antibiotics through an intravenous line in the operating room right before surgery begins and again at the end, and two more times afterward. The most common antibiotic is cefazolin; vancomycin is added for those at risk for certain infections. If you're allergic to either of these antibiotics, your team will select alternatives. Many other precautions will be observed during surgery, including adequate sterile technique and limited traffic in the operating room. 

Precautions after surgery

If you've had joint-replacement surgery, you'll need to follow these precautions:

  • Delay elective high-risk dental procedures, elective gastrointestinal endoscopy and high-risk urologic procedures for at least six months after the procedure. 
  • If you develop active dental problems, they need to be evaluated and treated immediately. 
  • You should receive antibiotics one hour before dental work for the first year after surgery. 
  • If you're undergoing certain high-risk urologic procedures, you'll be given antibiotics one hour before the procedure for the first year after joint replacement. 

Preventing infection is of the utmost importance when considering orthopedic surgery. Improving your general health, avoiding nicotine products, and washing off bacteria from your skin and nose will help. Your surgical team will let you know when antibiotics are needed, as well. 

Lori McGowan, PA-C, has worked in the Department of Orthopedic Surgery since 2010. She is supervisor for Employee and Community Health's (ECH) Podiatry and Musculoskeletal work units. Lori currently helps patients in the Musculoskeletal Integrated Community Specialties Practice in the Baldwin Building. Her areas of interest include hip, knee, shoulder, foot and ankle orthopedic conditions.