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Sterile Procedures - BOA Guidelines, 1995

Background

The consequences of deep infection following orthopaedic operations can be catastrophic. Infection following joint replacement infection leads to loss of the prosthesis & prolonged disability. Revision arthroplasty following infection is technically difficult & both the operating time & duration of hospital admission may be 2-3 times longer than for primary joint replacement. Revision for infection is time-consuming, costly & erodes resources available for primary joint replacement.

A low incidence of infection depends upon operating theatre design, meticulous surgical technique & rigid aseptic discipline within the operating theatre suite. In recent years the high standards maintained by orthopaedic surgeons have been questioned by some outside our speciality including managers, microbiologists, nurses & operating department assistants. Some of these individuals have refused to adhere to the exacting standards required for joint replacement.

The early infection rate following total hip replacement in standard operating theatres without modern aseptic precautions was as high as 11% but a combination of prophylactic antibiotics & clean air can reduce the infection rate to 0.3%. An infection rate of 0.38% has been reported for uncomplicated primary THR but an infection rate of 1-2% may be more common.

Papers which show that omitting the use of face masks in general surgery where there is an infection rate approaching 5% have no relevance to orthopaedic surgery. There is no published evidence to support a relaxation of sterile procedures for orthopaedic surgery.



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