Infection continues to be a real problem in orthopaedic practice. Infection is probably the first cause of failure of orthopaedic and trauma operation, it is behind prolonged suffering for our dear patients because of the morbidity and mortality. Although there have been significant reduction in infection due to better surgical techniques, improved operating room environment, more effective antibiotics and the wide spread use of prophylactic antibiotics, we all will face this bad omen in one of our patients at some time in our practice.
Sadly, infection continues to happen despite our strenuous efforts to prevent it. Prolonged hospital stay to treat infection may expose the patients to resistant nosocomial pathogens.
The incidence of infection varies considerably worldwide; I think the incidence in our locality is very high. The current use of ultra clean air, antibiotics, and exhaust ventilated suits during implantation of prostheses considerably reduced infection. Nevertheless, lack of agreement and controversies still exist regarding the benefit of these very strict infection prevention techniques.
Infections are considered nosocomial if there is no evidence that the infection was present or incubating at the time of hospital admission.
Infection is considered related to surgery if that occurs at the incision site within 30 days after surgery, if no implant is left in place or within one year if the implant is in place.
Infection may occur at all anatomical levels, from the treatment point of view it is vital to precisely allocate the anatomical site of infection.
Infection is usually diagnosed depending on clinical features which are to be confirmed by laboratory tests. The presence of pus does not always mean infection, because necrosis of malignant lesion may simulate purulent material. Frequently, patients who have prostheses may be readmitted to the hospital for medical care or other surgical procedures during that time, the bladder catheter, intravascular line, that involve contaminated areas of the body may increase the risk of nosocomial infection.
A high risk of infection is present in collagen disease, malnutrition, steroid dependent and other immune suppression drugs, sicklers, hidden nidus of infection anywhere in the body and any operation that lasted longer than the anticipated surgical time.
The presence of diabetes mellitus is a concern in patient for surgery. Diabetes impairs the immune response to infection; therefore, wound healing may be difficult in those patients. In acute infection the influence of diabetes is much than in chronic infection. Some patients may have more than one risk factor.