teria. That's why surgical efficiency is of paramount importance.
Keeping operating times as short as possible limits the amount of time
the joint is exposed and may lower the risk of infection.
Surgical efficiency carries its own concerns, though. More and more
surgeons are replacing joints through smaller and smaller incisions,
with the aim of limiting exposure. But one of the pitfalls of minimally
invasive joint replacement is that the stretching of tissue it requires can
damage the skin and affect its healing and infection-fighting abilities. As
a result, a slightly larger incision may be a safer approach.
Experts have questioned and studied the effectiveness of laminar air-
flow in driving airborne bacteria away from the sterile field, but the
ventilation technology isn't a practical option for many hospitals and
surgery centers. Given its expense, most make do with standard ventila-
tion and HEPA filtration.
On the other hand, it doesn't take much time or money to use barri-
er garments in every joint replacement case. The surgeon, assistant
and tech should don a "moon suit" in order to avoid contaminating
the site. For the members of the surgical team who aren't wearing
moon suits, their entries into and exits from the room should be kept
to an absolute minimum. Limiting OR traffic and the resulting air
exchanges is thought to decrease the risk of SSIs. We put a warning
sign on the outside handle of the door that reads "Joint Replacement
In Progress," and make sure no one leaves the room unless we need a
replacement instrument or a different-sized implant.
5. Flush the wound
Some researchers are testing the effectiveness of powdered antibi-
otics sprinkled over the wound before closing, but in the meantime
there's a solution that you already have on hand. A few years ago,
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