sive to manage — it
costs about $18,000 to
treat a standard bacteri-
al infection with a revi-
sion surgery and more
than $100,000 to treat a
MRSA SSI — with no
guarantee the infection
will be eradicated.
We zeroed out our
SSI rate in this chal-
lenging and high-conse-
quence patient population by focusing on these fundamental infection
practices.
1. Identifying at-risk patients
Joint infection patients are at high risk of infection if they have multiple
comorbidities, including uncontrolled diabetes, obesity, hypertension or a
compromised immune system. Efforts to prevent infection begin with
appropriate patient selection and mitigating risk factors in the weeks lead-
ing up to surgery:
• smokers should kick the habit at least 6 weeks out;
• patients with a body-mass index over 38 should lose weight until their
BMI is at an acceptable threshold (< 35, for example); and
• diabetics should be treated with medication, diet and exercise until
their A1C is under 7.
Patients should also improve their diets at least 30 days before surgery
by hydrating properly and eating plenty of proteins. (They should continue
a high-protein diet for 6 weeks post-op.)
2 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9
• TIGHT SQUEEZE Tourniquets create a bloodless surgical field, but also increase risk of
infection-causing hematomas forming and hemarthrosis occurring in and around joints.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
