Preoperative evaluation and perioperative care 

• Screen for MSSA or MRSA carriage with a single nose swab culture (repeat if surgery delayed > 1 month)
• Carriers of MSSA or MRSA have staphylococcal load reduction performed in the week prior to surgery
• Preoperative urine cultures are NOT indicated
• Shower on day of surgery (normal soap)
• Apply non-rinse chlorhexidine 2% aqueous wipes to skin below the neck on day of surgery –  at home or in hospital by nursing staff
• For other notes- see reference

Reference:  PD2017_013_PCP_33_Pre_Operative_Procedures_for_the_prevention_of_surgical_site_infections

Note: for mupirocin resistant isolates of S. aureus, octenidine nasal gel is recommended as per this PCP.

Information sheets (HNE Health):

• Pre_Procedure_staphylococcal_load_reduction_-_Information_for_clinicans_V2 IPS-003-FACT-1.2
• Pre_Procedure_Staph._load_reduction_before_a_procedure_Patient_Information_V2 IPS-036-FACT-1.5
• Cleansing_your_skin_before_a_procedure_or_surgery_using_Chlorhexidine_wash_cloth Patient Information IPS-018-FACT-1.1
• Chlorhexidine_Wash_Cloth_Staff_Information_IPS-023-FACT-1.2

Surgical antibiotic prophylaxis

• For elective prosthetic joint surgery a single preoperative dose is now required (cefazolin IV).  Redose for procedures lasting more than 4 hours.
• For other important notes- see reference

Surveillance of prosthetic joint infection

As per the NSW Clinical Indicator Manual, version 3, both primary and revision prosthetic knee and hip operations undergo surveillance for deep post-operative infection that occurs within 90 days of surgery. Superficial infections are reported out to 30 days. The surveillance approach involves detection of infection during the inpatient stay or infection that requires readmission to any HNE Health hospital.  The USA (NHSN) surveillance definitions for surgical site infection are used. Infections are recorded on the HNE Infection Prevention Service database (ICNet) and then reflected from that into the HNE eMR (CAP ORION) as a clinical document (see reference).

References 

• HNELHD CG 20_59 Surgical Antibiotic Prophylaxis
• IPS-057-FACT-1.0 ICNET CAP Infection events