5zTSZk). The researchers discovered 95% of the patients who weighed
more than 120 kg were under-dosed and had higher rates of infection
at 1 year post-op than patients who were adequately dosed.
Patients who weigh more than 120 kg require 3 g of cefazolin,
according to study lead author Alex Rondon, MD, MBA, a surgical resi-
dent at the Rothman Institute in Philadelphia, Pa. He also suggests
these weight-based doses for lighter patients: 1 g for patients weighing
less than 60 kg and 2 g for patients weighing between 60 kg and 120
kg.
3. Use CHG wipes. Give every patient chlorhexidine gluconate
wipes to apply at home the night before surgery and again in pre-op
on the day of surgery, says Ms. Yerkes.
4. Control patients' glucose. Surgical stress antagonizes insulin
and leads to hyperglycemia, which impairs the ability of leukocytes to
stop infection, says Dr. Chen. "Patients who are not diabetic can have
high blood glucose levels after surgery," she says. Patients should
have blood glucose readings of less than 200 mg/dL and hemoglobin
A1c of less than 8% before undergoing surgery. "Those are important
numbers," says Dr. Chen. "You should be paying attention to them."
Also make sure patients have glucose readings less than 180 mg/dL at
18 to 20 hours post-op to aid in recovery.
5. Maintain normothermia. Ms. Yerkes's team uses forced-air
warming to prevent hypothermia before, during and after procedures.
She's aware of the federal lawsuits filed by thousands of patients who
allege the devices are to blame for their deep wound infections during
joint replacement surgery, but has no immediate plans to change the
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