While orthopaedic trauma surgery has significantly improved the quality of life for countless individuals, the postoperative period presents significant challenges, including the possibility of surgical site infections (SSIs) that can lead to prolonged hospitalization, increased healthcare costs, and patient distress. These SSIs are not to be underestimated, as they are associated with heightened susceptibility to adverse health outcomes, elevated morbidity, and even mortality.
The Role of Systemic Antibiotic Prophylaxis (SAP)
One approach to reducing the risk of SSIs in orthopedic surgery is the implementation of Systematic Antibiotic Prophylaxis (SAP). Administering antibiotics before surgery is a preventative measure that can prevent infections. It is essential to strike a balance when using SAP, ensuring effective antibiotic stewardship protocols are maintained while preventing SSIs. This approach not only reduces negative outcomes but also mitigates the emergence of antibiotic resistance, a growing concern in healthcare.
The risk of SSIs in orthopaedic surgery varies according to the type of procedure, such as closed fractures, open fractures, arthroplasty, or percutaneous fixation. Each procedure has unique attributes that influence the choice of antibiotics and treatment protocols. This necessitates a tailored approach to infection control to ensure optimal outcomes for the patients.
Predicting Postoperative SSIs with a Nomogram
One study developed a nomogram to estimate the probability of postoperative SSIs in orthopedic patients. This predictive model, established through logistic regression analysis, serves as a valuable tool for assessing infection risk. The study showcased the model’s effectiveness through external and internal validation, indicating its practicality and reliability for clinical use.
Antimicrobial Resistance in Disaster Settings
Orthopaedic surgery faces distinct challenges in disaster settings where crush injuries are prevalent. These injuries are often associated with increased infection caused by aerobic gram-negative bacteria, including highly resistant strains like Acinetobacter baumannii. To effectively combat antimicrobial resistance in such scenarios, strengthening surveillance and diagnostic capabilities is imperative.
Non-Technical Skills Role in Preventing Infection
However, the improvement of patient safety in orthopedic surgery extends beyond antibiotic prophylaxis. It includes addressing non-technical skills that contribute significantly to surgical outcomes. Studies have shown that non-technical skills, such as effective communication, professionalism, teamwork, and clinical leadership, play a crucial role in reducing human errors. These skills can be integrated into surgical training to enhance surgeons’ abilities, ultimately improving patient care, and preventing infection.
Orthopaedic specialties face the challenge of making non-technical skills education relevant and attractive to surgeons. Current non-technical skills courses are often general and not specialty-specific, potentially leading some surgeons to perceive them as irrelevant. Identifying the most pressing non-technical skill requirements for orthopedic surgeons can help tailor training programs to their needs.
Moreover, focusing on non-technical skills not only benefits patients but also helps prevent errors in the operating room, which can have severe consequences in orthopedics. Collaboration among surgical team members, including surgeons, anesthetists, nurses, and support staff, is crucial to create a culture of safety and ultimately work towards preventing infections.
Infection control in orthopaedic trauma surgery is multifaceted and requires a comprehensive approach, encompassing antibiotic prophylaxis, patient risk assessment, non-technical skills training, and preparedness in disaster settings. Improving patient safety and minimizing SSIs in orthopaedic surgery is a collective effort that demands attention to detail, adaptability, and a commitment to continuous improvement in healthcare practices.
