Risque infectieux en chirurgie orthopédique

Abstract

In the orthopaedic field, the specifically patient-related risk factors for infection may be evaluated using the NNIS (National Nosocomial Infection Surveillance) score that takes into account non-adjustable data such as the patient’s condition as evaluated by the score ASA, intervention duration, type of intervention, etc. The risk of infection depends also on numerous factors of which the most important have an influence during the perioperative period. Some of them are patient-related (cutaneous flora, methicillin-resistant Staphylococcus aureus (MRSA), underlying disease, pre-existing infection, patient with multiple trauma …), others are related to the patient’s environment (operating theatre, air and water quality, hygiene of the surgical team and caregivers, instruments …). The patient with multiple traumas has a specific risk of infection related to the multiple traumatic lesions, visceral lesions, and to those invasive acts necessary for resuscitation. Actions aimed at diminishing the risk of infection may be undertaken, principally on this second group of factors. In particular for the preoperative period, validated procedures allow reducing the risk of contamination: preparation of the patient, hygiene standards for the operating theatre, surgical hand cleaning, quality of air and water, adequate antibioprophylaxis, management of other diseases, preoperative duration of hospitalisation, etc. A recent study has emphasized the potentially increased risk of contamination by MRSA related to the underutilization of sepsis containment units. Regulatory recommendations and traceability obligations aim at standardizing and optimizing preventive means. Informing the patient on the infectious risk and its consequences is a mandatory part of the traumato-orthopaedic surgical management.