PROSTHETIC SURGERY AND INFECTION CONTROL: THE EXPERIENCE OF CLINICA SAN FRANCESCO

In the orthopaedic surgery field the articular prosthesis implantation is constantly increasing, especially due to the ageing of population. Patients more elder often means more fragile and exposed to the more serious complications. In case of prosthetic replacement operation the most feared complication is the periprosthetic infection that appears when the metal surface of prosthesis becomes ideal ground for the bacterial growth safe from body immune system.

The incidence percentage of this infection varies from 1,5% to 2% for hip prostheses and from 2,5% to 5% for the knee ones. “These percentages remained unchanged significantly in time altough the optimization of techniques and the surgery times, the rules of sterility observed in operating rooms and the antibiotic prophylaxis perioperative because the profile of patients has changed; patients more complex and affected by age-related diseases who once hardly underwent to prosthetic replacements are now operated – MD Maurizio Solbiati, San Francesco’s infectious diseases consultant explained us. Therefore it is not a failure being kept at such infection levels. The periprosthetic infections take a role of primary importance in causing a continuation of postoperative bedridden hospital stay, absence from work, additional costs related to the pharmacological antibiotic therapy and so negative economic repercussions”.

The activities of prevention and control of infection risk represent a central element in the clinic management and are integral part of risk management and continuous improvement of quality realized by the Clinica San Francesco. For this reason for a long time there is within the facility a Control Committe of Healthcare-associated Infections as provided for in the current health laws.

“The identification, assessment, prevention and management of infection risk are coordinated by the Control Committee of Healthcare-associated Infections and carried out in collaboration with the Clinic hygiene and clinical engineering services, and are based on clinical and laboratory surveillance, control and periodic review of procedures concerning all the activities related to the infection risks and continuous training of the staff – MD Solbiati explained -. The infection prevention of the surgery site is based on three moments: before, during and after the operation. Just at the moment of anamnestic data collection and in view of the preoperative tests the possible risk factors are assessed (obesity, malnutrition, smoking, diabetes, therapies with cortisone, asymptomatic urinary infections, immunodepression) and can be mitigated or corrected. Furthermore it is provided a vademecum containing what needs to be done before the operation (shower, possible shaving, etc.). The perioperative moment, namely immediately before-during-immediately after the operation, is based on the proper antibiotic prophylaxis (choice of drug, dosage, timing of administration), on accurate antiseptic wash of providers hands, on preparation and disinfection of skin in the surgery site, on the use of laminar flow ventilation systems and diving suits similar to space suits by the surgery team which provide for also the protection of face and head with a helmet, the use of minimally invasive and microinvasive surgical procedures (as the robotic one) and the rationalization of staff movements in the operating room. The following postoperative phase in stay ward requires an adecuate management of surgical wound and possible drainages in order to minimize the length of stay in the Clinic and lastly consists in the taking care of patient once discharged.

The Clinica San Francesco is engaged in the constant effort to adhere to the international and national guidelines (above all those issued by the Italian Orthopaedics and Traumatology Society), with the permanent training of all health staff involved in the protocol application with audit periodic checks: “The lack of validated and shared procedures represents one of the main risk factor for the onset of healthcare-associated infections – MD Solbiati concluded -. However also the patients and relatives must be encouraged to know and use the most effective prevention procedures, to reach togheter with the Clinic the aim of infections decrease”.