Preventing Infection in Shoulder Replacement Surgery.
Infection is a rare but serious complication of shoulder arthroplasty surgery. In the rare circumstance where infection does occur the shoulder prosthesis may need to be removed and a new replacement surgery performed after treatment with high dose antibiotics. Dr Cutbush’s rate of infection for patients undergoing shoulder replacement is very low being well under 1%.
Beyond meticulous surgical technique and obsession with surgical sterility Dr Cutbush prepares his patients for joint replacement surgery utilising a fastidious preoperative programme based on the latest scientific research available.
Step 1
All patients are seen by an experienced Physician prior to surgery to ensure that all medical issues are identified and their treatment optimised. You will have blood tests performed to check the health of your major organ systems and to ensure that you don’t have a low red blood cell count (anaemia). In the uncommon circumstance where a patient does have anaemia this will need to be corrected prior to surgery to reduce the risk of infection and the possible need for blood transfusion. This approach of having all patients undergo a medical check up before undergoing joint replacement surgery has been shown to reduce the rate of complications of surgery including the potential risk of infection. It has also been shown to be cost effective. Prominent medical societies now recommend this approach.
Step 2
When you are listed for shoulder replacement surgery Dr Cutbush’s staff will give you several surgical wash cloths. You will be asked to shower using these cloths containing chlorhexidine, hospital grade disinfectant, for the two nights prior to coming in to hospital for surgery. Washing your whole body with a hospital disinfectant cloth dramatically reduces the amount of bacteria present on your skin and the risk of bacteria contaminating your surgery.
Step 3
Dr Cutbush’s staff will give you a script for mupiricin nasal ointment. This is an antibiotic ointment that you will be asked to apply to both your nostrils twice a day for five days prior to surgery.
There is now compelling scientific evidence that approximately 70 to 80% of Staphylococcal aureus (Golden staph) wound or blood borne infections are genetically identical to bacteria harboured in the nose of patients that contract these infections. Studies have shown approximately 80% of people harbour Staphylococcal bacteria in their nose from time to time. Testing has shown that at any one time 30% of people are carrying these bacteria in their nasal passages without being aware they are. Swab testing can be performed to check whether these bacteria are present, however, the tests are unreliable and only identify half of the people carrying the bacteria.
Mupiricin ointment is very effective at eradicating the bacteria from the nose and nasal passages. Studies have shown that eliminating the bacteria from the nose has the added flow on effect of eliminating these bacteria from a patient’s axilla and groin regions where these bacteria can also be found.
Eradicating the Staphylococcal bacteria from a patient’s body prior to surgery is believed to reduce the risk of Staphylococcal infection (Golden Staph) by 70 to 80%.
