Adherence to Recommendations Designed to Decrease Intra-Operative Wound Contamination

Abstract

The incidence of wound infection following total hip and knee arthroplasty has fallen with the introduction of laminar vertical laminar airflow, occlusive clothing and prophylactic antibiotics. However, infection still occurs after prosthetic joint replacement and can have devastating consequences. Intra-operative wound contamination is the major source of infection. Measures proven to decrease intra-operative wound contamination include chlorhexidine lavage, removal of jewellery, covering old jewellery, ears, nose, mouth and hair and wearing theatre clothing in an occlusive manner. Posters explaining this practice were placed at eye level in the scrub area of orthopaedic theatres and adoption of these techniques was observed covertly before and after. Eighty-two personnel were audited before the poster was erected and 90 afterwards. Only 2 of 12 observed standards were adhered to 100% of the time. Education by posters did not significantly improve adherence to protocols. Compliance with protocols was worse amongst non-scrubbed theatre personnel.