Prevention of surgical site infections in bone and joint procedures.

There is strong evidence that preoperative nasal S. aureus screening/decolonization will significantly reduce surgical site infections (SSIs) after joint prostheses implantation. There is some evidence that antibiotic-containing bone cement may lower SSI rates. Timely administration of perioperative systemic antibiotic prophylaxis is recommended for patients with implants who are undergoing dental treatment, urogenital surgery, upper endoscopy, sigmoidoscopy, or colonoscopy. Advanced skin disinfection by chlorhexidine-gluconate-impregnated cloths may be protective. There is evidence that clippers are favored for hair removal, rather than razors, but no significant advantage, as compared with other modes of hair removal, has been found. Antibiotic-coated intramedullary nails and antibiotic-impregnated bone grafts may be useful for the treatment of chronic bone infections. No recommendation can be made for wound dressing types. Laminar air flow systems do not seem to prevent SSI but may even cause harm, instead. There is a strong association between the annual number of surgical procedures and low SSI rates.