Timing of preoperative antibiotics for knee arthroplasties: Improving the routines in Sweden

Patient Safety in Surgery

Lars Lidgren²  Pelle Gustafson²  Anna Stefánsdóttir²  Otto Robertsson¹  Annette W-Dahl² 

[1] The Swedish Knee Arthroplasty Register, Department of Orthopedics Skåne University Hospital Lund, 221 85 Lund, Sweden;Department of Orthopedics, Skåne University Hospital Lund, 221 85 Lund, Sweden

关键词: Preoperative routines;    Prophylactic antibiotics;    Infection prophylaxis;    Knee arthroplasty;   

Others  :  790384
DOI  :  10.1186/1754-9493-5-22

 received in 2011-06-21, accepted in 2011-09-19,  发布年份 2011

【 摘 要 】

Background

A slight increase in revisions for infected joint arthroplasties has been observed in the Nordic countries since 2000 for which the reasons are unclear. However, in 2007 a Swedish study of the timing for prophylactic antibiotics in a random sample of knee arthroplasties found that only 57% of the patients had received the antibiotic during the optimal time interval 45-15 minutes before surgery. The purpose of the report was to evaluate the effect of measures taken to improve the timing of prophylactic antibiotics.

Findings

Reporting this finding to surgeons at national meetings during 2008 the Swedish Knee Arthroplasty Register (SKAR) introduced a new report form from January 2009 including the time for administration of preoperative antibiotics. Furthermore, the WHO's surgical checklist was introduced during 2009 and a national project was started to reduce infections in arthroplasty surgery (PRISS). The effect of these measures was found to be positive showing that in 2009, 69% of the 12,707 primary knee arthroplasties were reported to have received the prophylaxis within the 45-15 min time interval and 79% of the first 7,000 knee arthroplasties in 2010. A survey concerning the use of the WHO checklist at Swedish hospitals showed that 73 of 75 clinics had introduced a surgical checklist.

Conclusions

By registration and bringing back information to surgeons on the state of infection prophylaxis in combination with the introduction of the WHO checklist and the preventive work done by the PRISS project, the timing of preoperative prophylactic antibiotics in knee arthroplasty surgery was clearly improved.

【 授权许可】

   
2011 W-Dahl et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Jämsen E, Furnes O, Engesæter LB, Konttinen YT, Odgaard A, Stefánsdóttir A, Lidgren L: Prevention of deep infection in joint replacement surgery A review. Acta Orthop 2010, 81(6):660-666.
• [2]Schrama JC, Espehaug B, Hallan G, Engesaeter LB, Furnes O, Havelin LI, Fevang BT: Risk of revision for infection in primary total hip and knee arthroplasty in patients with rheumatoid arthritis compared with osteoarthritis: a prospective, population-based study on 108,786 hip and knee joint arthroplasties from the Norwegian Arthroplasty Register. Arthritis Care Res (Hoboken) 2010, 62(4):473-9.
• [3]Swedish Knee Arthroplasty Register: [http://www.knee.se/] webciteAnnual report 2010. Lund University Hospital, Lund; 2010.
• [4]AlBuhairan B, Hind D, Hutchinson A: Antibiotic prophylaxis for wound infections in total joint arthroplasty. A Systemic Review J Bone Joint Surg (Br) 2008, 90(7):915-9.
• [5]Stefánsdóttir A, Robertsson O, W-Dahl A, Kiernan S, Gustafson P, Lidgren L: Inadequate timing of prophylactic antibiotics in orthopedic surgery. We can do better. Acta Orthop 2009, 80(6):633-8.
• [6]Gyssens IC: Preventing postoperative infections: current treatment recommendations. Drugs 1999, 57:175-85.
• [7]Polk HC Jr, Christmas AB: Prophylactic antibiotics in surgery and surgical wound infections. Am Surg 2000, 66(2):105-11.
• [8]Galandiuk S, Polk HC Jr, Jagelman DG, Fazio VW: Re-emphasis of priorities in surgical antibiotic prophylaxis. Surg Gynecol Obstet 1989, 169:219-22.
• [9]Tomita M, Motokawa S: Effects of air tourniquet on the antibiotics concentration, in bone marrow, injected just before the start of operation. Mod Rheumatol 2007, 17(5):409-12.
• [10]W-Dahl A, Toksvig-Larsen S: Infection prophylaxis A prospective study in 106 patients operated on by tibial osteotomy using the hemicallotasis technique. Arch Orthop Trauma Surg 2006, 126(7):441-7.
• [11]Robertsson O, Lewold S, Knutson K, Lidgren L: The Swedish Knee Arthroplasty Project. Acta Orthop Scand 2000, 71(1):7-18 7.
• [12]World Health Organization: WHO Patient Safety. [http://www.who.int/patientsafety/] webcite
• [13]Landstingens Ömsesidiga Försäkringsbolag (Patient Insurance) [http://www.patientforsakring.se] webcite
• [14]Phillips JE, Crane TP, Noy M, Elliott TS, Grimer RJ: The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg (Br) 2006, 88(7):943-8.
• [15]Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J: Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop 2008, 466(7):1710-5.