| Budget Amount *help |
¥2,040,000 (Direct Cost: ¥1,800,000、Indirect Cost: ¥240,000)
Fiscal Year 2007: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000)
Fiscal Year 2006: ¥1,000,000 (Direct Cost: ¥1,000,000)
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| Research Abstract |
The objective of the present study was to verify the efficacy and cost-effectiveness of preoperative procedures prior to total hip arthroplasty (THA) against surgical site infection(SSI).
1. Survey of actual conditions for preoperative sterilization prior to THA
To investigate preoperative sterilization prior to THA, a nationwide questionnaire survey was conducted of 1967 Japanese medical centers with an orthopedic surgery department and >200 beds. Valid responses were obtained from 618 centers. The results showed that preoperative sterilization was performed at 612 centers (99%), and the most common answer was bathing or showering in 324 centers (52.4%). However, only 36 centers (5.8%) used Centers for Disease Control and Prevention (CDC) -recommended disinfectants in showering. With regard to the location of skin sterilization, the most common answer was the operating room in 367 centers (59.4%). Also, with regard to materials used for skin sterilization, gauzes were the most common an
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swer, but brushes were used at 21 centers (3.4%). Over the past year, 80 centers (14.2%) experienced postoperative wound infections. Rates of infection were compared with respect to location of sterilization, but no significant differences were seen among ward, operating room or ward plus operating room. Furthermore, no significant differences existed with respect to materials used for skin sterilization, in terms of skin brush versus others (gauze). The above findings clarified that compared to a similar survey conducted in the Kansai, Chubu and Kanto regions in 1999, Japanese centers now employ techniques that more closely resemble CDC-recommended guidelines.
2. Comparison of rates of postoperative wound infection with respect to various preoperative skin sterilization techniques
At centers with strict skin sterilization protocols (Group A, n=10), hair is removed using an electric clipper the day before surgery, and 3 h before surgery, the skin is sterilized twice and covered with a sterile cloth in the ward, and a balloon catheter is placed. Next, the patient is transferred to the operating room and the skin is sterilized again inside the operating room. At centers that follow CDC-recommended guidelines (Group B, n=27), hair is not shaved, nor is skin sterilized in the ward, and the skin is sterilized only in the operating room. Preoperative antibiotic administration is a significant risk factor, and in both groups, antibiotics were administered 30 min before surgery. No significant differences existed in patient age, body-mass index, wound classification or American Society of Anesthesiologists (ASA) score, but significant differences were seen in gender ratio, complications (cardiovascular disease) and duration of hospitalization. The small sample size was insufficient to allow firm conclusions to be drawn, but since SSI was not seen in either group, conventional strict protocols will need to be reevaluated. In the future, more cases must be examined and statistical analyses need to be conducted. As SSI did not occur, comparing medical costs between THA patients with and without SSI was not possible, In the future, we plan to investigate this issue by examining THA patients with SSI. Less
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