Table 3
Intra-operative measures and strategies for preventing PJI.
| Measures | Strategy |
|---|---|
| Limit OR traffic | Ensuring access to frequently used instruments, utilisation of intercom, and keep door movements per surgical procedure to a minimum |
| Double gloving | Gloves should also be changed every 30–60 min [56] |
| Meticulous skin preparation | Iodine and alcohol-based solutions are recommended for skin preparation [57]. Diluted betadine is recommended by WHO and CDC [57] |
| Frequent change of blade | Blade change following skin incision |
| Reduce operative time | Prolonged operative time increases the risk of wound contamination [58] |
| Thorough irrigation | Pulsed lavage efficacy of eradicating organisms by 100 times greater than that of a spherical syringe [59] |
| Prophylactic administration of antibiotics | A first-generation cephalosporin [60] or clindamycin should be administrated within 30 minutes of the incision.Vancomycin should be considered for Methicillin-resistant Staphylococcus aureus (MRSA) colonised patients or patients with a previous MRSA infection. |
| Minimise blood loss | Tranexamic acid is recommended for all THA patients unless there is a significant risk of embolism [61]. |
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