An exploration of the risk factors for developing deep wound infection after joint replacement surgery

Miss Karen McKenna1, Anastasia Hutchinson1, Mal Butler1

1Epworth Healthcare, Richmond, VIC, Australia


In Australia there are approximately 180,000 Healthcare Acquired Infections (HAIs) annually. Decreasing HAI has been identified as a quality improvement priority. Deep wound infection following joint replacement surgery have substantial impacts on patients’ outcomes and healthcare costs. The research literature identified two areas for infection prevention associated with joint replacements: preoperative screening and optimisation of risk factors and intraoperative interventions including: improved surgical technique, prophylactic antibiotics and rigorous infection control practices.

A systematic integrative review was completed focusing on interventions to optimise human and environmental factors that affect microbial load in the operating room (OR). The aim of this review were to evaluate behavioural factors that increase microbial load within the OR, to evaluate interventions to decrease transmission of airborne contamination in the OR.

The integrative approach was chosen as included studies used wide-ranges of research designs: randomised controlled trials, cohort studies, cross sectional observational studies and experimental studies using simulated environments.
The study population observed were patients undergoing joint replacement surgery. Intervention/exposure included studies evaluating: OR foot traffic and air filtration system used. Study outcomes measured were: airborne particulate and microbial load, compliance with infection prevention, staff behaviour to change.

Outcomes of this review identified that evaluating effectiveness of airflow systems using surgical infections (SSI) as a measure was ineffective. When measuring the effectiveness of airflow systems using air quality, results demonstrated a decrease in particle counts with the use of laminar airflow systems. Factors that affected air quality included OR traffic and staff volume.


Karen McKenna is the Operations Manager for the Infection Prevention & Control unit at Epworth healthcare in Melbourne.

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